Individual
THERESA ELIZABETH SHANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD LDN
Contact information
Practice address
1632 PINE ST, PHILADELPHIA, PA 19103-6711
(215) 735-7992
Mailing address
1909 GREEN ST, APARTMENT 2N, PHILADELPHIA, PA 19130-3244
(717) 203-9728
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN004553
PA
Other
Enumeration date
01/21/2013
Last updated
03/04/2014
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