Organization
PHILLY DIETITIAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THERESA ELIZABETH SHANK (REGISTERED DIETITIAN)
(717) 203-9728
Entity
Organization
Contact information
Practice address
1909 GREEN ST, PHILADELPHIA, PA 19130-3244
(717) 203-9728
Mailing address
1909 GREEN ST, PHILADELPHIA, PA 19130-3244
(717) 203-9728
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN004553
PA
Other
Enumeration date
11/02/2015
Last updated
11/02/2015
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