Healthcare Provider Details

I. General information

NPI: 1467885483
Provider Name (Legal Business Name): MARY KAY A. D'ELIA RDN, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ALDER ST UNIT 2
SCRANTON PA
18505
US

IV. Provider business mailing address

8 PEACHWOOD DRIVE
LAFLIN PA
18702-7262
US

V. Phone/Fax

Practice location:
  • Phone: 570-880-7130
  • Fax:
Mailing address:
  • Phone: 570-237-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001083
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0019462370005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0019462370004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier1007678420040
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier0019462370001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier1007678420041
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 6
Identifier1007678420042
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: