Provider Demographics
NPI:1528860772
Name:CERNICH, ELLEN (MS, RD, CDCES)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:CERNICH
Suffix:
Gender:F
Credentials:MS, RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NEWGATE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-1001
Mailing Address - Country:US
Mailing Address - Phone:412-860-3575
Mailing Address - Fax:
Practice Address - Street 1:25 NEWGATE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-1001
Practice Address - Country:US
Practice Address - Phone:412-860-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003715133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered