Provider Demographics
NPI:1750603353
Name:EMMANUELLI, NOEL A (RD)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:A
Last Name:EMMANUELLI
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW 12TH AVE
Mailing Address - Street 2:(M851)
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1003
Mailing Address - Country:US
Mailing Address - Phone:305-243-6837
Mailing Address - Fax:305-243-8470
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:(M851)
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-243-6837
Practice Address - Fax:305-243-8470
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5108133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered