Provider Demographics
NPI:1932733995
Name:DENEEN, HEATHER ZICCARELLI (RDN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ZICCARELLI
Last Name:DENEEN
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 1:352 PIERCEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3445
Mailing Address - Country:US
Mailing Address - Phone:585-737-4134
Mailing Address - Fax:
Practice Address - Street 1:441 BULTMAN AVE
Practice Address - Street 2:1183
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-877-3330
Practice Address - Fax:912-876-3246
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered