Healthcare Provider Details

I. General information

NPI: 1164287850
Provider Name (Legal Business Name): JESSICA SPIRO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 STRAFFORD AVE STE 1
WAYNE PA
19087-3340
US

IV. Provider business mailing address

866 WHISTLE LN
MEDIA PA
19063-2171
US

V. Phone/Fax

Practice location:
  • Phone: 267-368-4568
  • Fax:
Mailing address:
  • Phone: 310-909-6057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN008448
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: