Individual
MARYELLEN CANOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3517 VAUX ST, PHILADELPHIA, PA 19129-1445
(215) 896-4664
Mailing address
3517 VAUX ST, PHILADELPHIA, PA 19129-1445
(215) 896-4664
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86390457
PA
Other
Enumeration date
04/23/2026
Last updated
04/23/2026
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