Provider Demographics
NPI:1861796732
Name:COLELLA, LYNANN M (RD, LDN)
Entity type:Individual
Prefix:
First Name:LYNANN
Middle Name:M
Last Name:COLELLA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-0716
Mailing Address - Country:US
Mailing Address - Phone:724-704-8886
Mailing Address - Fax:724-342-1942
Practice Address - Street 1:2120 LIKENS LN
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-2304
Practice Address - Country:US
Practice Address - Phone:724-983-8878
Practice Address - Fax:724-983-8881
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004496133V00000X
OHLD6706133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered