Individual
KELLY SORACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
1234 E DUPONT RD STE 3, FORT WAYNE, IN 46825-1545
(260) 425-5970
Mailing address
11109 PARKVIEW PLAZA DRIVE, MAILBOX 117, FORT WAYNE, IN 46845-1701
(260) 266-8210
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37001137A
IN
Other
Enumeration date
08/03/2020
Last updated
08/31/2020
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