Healthcare Provider Details

I. General information

NPI: 1255412805
Provider Name (Legal Business Name): MARNIE SHERNO R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY ROAD
MCGUIRE AFB NJ
08641
US

IV. Provider business mailing address

1006 HILL AVE
LANGHORNE PA
19047-3959
US

V. Phone/Fax

Practice location:
  • Phone: 609-754-3712
  • Fax:
Mailing address:
  • Phone: 215-530-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001035
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: