Provider Demographics
NPI:1043035728
Name:MAZZINO, MATT (RD, LD)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:MAZZINO
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11603 FIDELITY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3651
Mailing Address - Country:US
Mailing Address - Phone:440-567-8008
Mailing Address - Fax:
Practice Address - Street 1:11603 FIDELITY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3651
Practice Address - Country:US
Practice Address - Phone:440-567-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered