Healthcare Provider Details

I. General information

NPI: 1780646448
Provider Name (Legal Business Name): CHARLA MERVIS STEIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 NICOLE DR
DRESHER PA
19025-1438
US

IV. Provider business mailing address

1856 NICOLE DR
DRESHER PA
19025-1438
US

V. Phone/Fax

Practice location:
  • Phone: 610-608-9707
  • Fax:
Mailing address:
  • Phone: 610-608-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003198
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: