Healthcare Provider Details

I. General information

NPI: 1326855800
Provider Name (Legal Business Name): MEDINAH A BEY RDN ELIGIBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 W OXFORD ST
PHILADELPHIA PA
19121-2729
US

IV. Provider business mailing address

2929 W OXFORD ST
PHILADELPHIA PA
19121-2729
US

V. Phone/Fax

Practice location:
  • Phone: 267-475-1290
  • Fax:
Mailing address:
  • Phone: 267-475-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: