Organization
PHILADELPHIA NUTRITION AND WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON LEIGH SHORE RD (OWNER/DIETITIAN)
(267) 314-7675
Entity
Organization
Contact information
Practice address
451 HERMITAGE ST, PHILADELPHIA, PA 19128-3301
(267) 314-7675
Mailing address
451 HERMITAGE ST, PHILADELPHIA, PA 19128-3301
(610) 506-7112
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
07/15/2021
Last updated
01/05/2022
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