Provider Demographics
NPI:1467080408
Name:MANCELLA, GABRIELLE MARIE (RD/LDN)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:MARIE
Last Name:MANCELLA
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 1:238 THORNTON LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3066
Mailing Address - Country:US
Mailing Address - Phone:407-719-0743
Mailing Address - Fax:
Practice Address - Street 1:238 THORNTON LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3066
Practice Address - Country:US
Practice Address - Phone:407-719-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2024-05-23
Deactivation Date:2020-03-30
Deactivation Code:
Reactivation Date:2024-05-23
Provider Licenses
StateLicense IDTaxonomies
FLND7573133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty