Provider Demographics
NPI:1972331593
Name:PELLY, AVI MAE (RDN)
Entity type:Individual
Prefix:
First Name:AVI
Middle Name:MAE
Last Name:PELLY
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 1:75 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2941
Mailing Address - Country:US
Mailing Address - Phone:732-580-5426
Mailing Address - Fax:
Practice Address - Street 1:3250 W 66TH ST APT 548
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5514
Practice Address - Country:US
Practice Address - Phone:651-447-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered