Provider Demographics
NPI:1760357495
Name:PHELPS, MARCELLA E (FGP)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:E
Last Name:PHELPS
Suffix:
Gender:F
Credentials:FGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 YARDLEY CT
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2267
Mailing Address - Country:US
Mailing Address - Phone:336-935-1906
Mailing Address - Fax:
Practice Address - Street 1:1316 YARDLEY CT
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2267
Practice Address - Country:US
Practice Address - Phone:336-935-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1760357495133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education