MEDICARE: TRACY CARDELLI R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	D1438	ME

General Provider Information

NPI Number	:	1962442368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY CARDELLI R.D.

Provider Business Mailing Address
First Line	:	887 CONGRESS ST
Second Line	:	SUITE 320
City	:	PORTLAND
State	:	ME
Zip	:	04102-3100
Country	:	US
Telephone Number	:	207-662-5522
Fax Number	:	207-662-5527

Provider Business Practice Location Address
First Line	:	39 WALLACE AVE
Second Line	:
City	:	SO PORTLAND
State	:	ME
Zip	:	04106-6143
Country	:	US
Telephone Number	:	207-761-0650
Fax Number	:	207-761-8198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	06/03/2013

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Directions to “ TRACY CARDELLI R.D.” Practice Location

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