Individual
MATTHEW LICIARDELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1308 N HOPE ST UNIT A, PHILADELPHIA, PA 19122-4611
(267) 432-3206
Mailing address
1308 N HOPE ST UNIT A, PHILADELPHIA, PA 19122-4611
(267) 432-3206
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN641688
PA
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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