Provider Demographics
NPI:1124350053
Name:PANETTA, JESSICA L (RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:PANETTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:ONEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:726 CARMET RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3308
Mailing Address - Country:US
Mailing Address - Phone:267-627-2977
Mailing Address - Fax:267-627-2971
Practice Address - Street 1:2600 PHILMONT AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5306
Practice Address - Country:US
Practice Address - Phone:267-627-2977
Practice Address - Fax:267-627-2971
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004015133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered