Healthcare Provider Details

I. General information

NPI: 1336440106
Provider Name (Legal Business Name): SHELLEY SURBER RD,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AMERICAN ST
CATASAUQUA PA
18032-1800
US

IV. Provider business mailing address

300 AMERICAN ST
CATASAUQUA PA
18032-1800
US

V. Phone/Fax

Practice location:
  • Phone: 610-264-5471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003452
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: