Provider Demographics
NPI:1811747009
Name:DIETITIAN DRIVEN LLC
Entity type:Organization
Organization Name:DIETITIAN DRIVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:EVA
Authorized Official - Last Name:MARCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-878-0319
Mailing Address - Street 1:1325 MERIDEN AVE # A
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4219
Mailing Address - Country:US
Mailing Address - Phone:860-878-0319
Mailing Address - Fax:
Practice Address - Street 1:1325 MERIDEN AVE # A
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4219
Practice Address - Country:US
Practice Address - Phone:860-878-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty