MEDICARE: DANIELLE DECHELLIS RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	8287	FL
2	133V00000X	Registered Dietitian	63373161	PA

General Provider Information

NPI Number	:	1639610405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE DECHELLIS RD, LDN

Provider Business Mailing Address
First Line	:	1012 W ALFRED ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-5310
Country	:	US
Telephone Number	:	813-906-8372
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 W ALFRED ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-5310
Country	:	US
Telephone Number	:	813-906-8372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	10/28/2024

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