Provider Demographics
NPI:1427838994
Name:ZELLNER, ERICA (CNS, LDN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ZELLNER
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3425
Mailing Address - Country:US
Mailing Address - Phone:484-702-2452
Mailing Address - Fax:
Practice Address - Street 1:55 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-3425
Practice Address - Country:US
Practice Address - Phone:484-702-2452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007415133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist