Healthcare Provider Details

I. General information

NPI: 1174128698
Provider Name (Legal Business Name): PRISCILLA AYENI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 FEDERAL ST FL 2
PHILADELPHIA PA
19146-2829
US

IV. Provider business mailing address

2033 FEDERAL ST FL 2
PHILADELPHIA PA
19146-2829
US

V. Phone/Fax

Practice location:
  • Phone: 609-332-5936
  • Fax:
Mailing address:
  • Phone: 609-332-5936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDN004464
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004464
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: