Healthcare Provider Details

I. General information

NPI: 1578991923
Provider Name (Legal Business Name): ANDRA ADAMS RDLDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 CHESTER PIKE
SHARON HILL PA
19079-1411
US

IV. Provider business mailing address

907 CHESTER PIKE
SHARON HILL PA
19079-1411
US

V. Phone/Fax

Practice location:
  • Phone: 610-583-1177
  • Fax: 610-583-1510
Mailing address:
  • Phone: 610-583-1177
  • Fax: 610-583-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN002766
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: