Provider Demographics
NPI:1548974546
Name:ROVELLI, JULIETTE MARIE X (RD LDN)
Entity type:Individual
Prefix:
First Name:JULIETTE
Middle Name:MARIE
Last Name:ROVELLI
Suffix:X
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:JULIETTE
Other - Middle Name:M
Other - Last Name:GRAUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:3863 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3064
Mailing Address - Country:US
Mailing Address - Phone:732-616-3289
Mailing Address - Fax:
Practice Address - Street 1:3863 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-3064
Practice Address - Country:US
Practice Address - Phone:732-616-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL.D.7658133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered