Healthcare Provider Details

I. General information

NPI: 1003612623
Provider Name (Legal Business Name): ELIZABETH R SPERRAZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 DELAWARE AVE
WEST PITTSTON PA
18643-2101
US

IV. Provider business mailing address

231 DELAWARE AVE
WEST PITTSTON PA
18643-2101
US

V. Phone/Fax

Practice location:
  • Phone: 570-313-3132
  • Fax:
Mailing address:
  • Phone: 570-313-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: