Healthcare Provider Details

I. General information

NPI: 1386768984
Provider Name (Legal Business Name): SHELLEY L DEPINTO MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY L BOHANAK

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N MAIN ST ROOM 102C2
DUBLIN PA
18917-2107
US

IV. Provider business mailing address

304 TINSMAN DR
PERKASIE PA
18944-4422
US

V. Phone/Fax

Practice location:
  • Phone: 610-533-8860
  • Fax:
Mailing address:
  • Phone: 215-766-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003403
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: