Provider Demographics
NPI:1417778515
Name:CERULLO, BRIANNA (RDN)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:CERULLO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PRINCETON DR UNIT 301
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1740
Mailing Address - Country:US
Mailing Address - Phone:603-235-8894
Mailing Address - Fax:
Practice Address - Street 1:18 N MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4926
Practice Address - Country:US
Practice Address - Phone:603-223-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1931133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered