Healthcare Provider Details

I. General information

NPI: 1639209406
Provider Name (Legal Business Name): ROSEANNA ANDERSON RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WASHINGTON LANE SUITE 6A2
WYNCOTE PA
19095
US

IV. Provider business mailing address

447 PLYMOUTH ROAD
GLENSIDE PA
19038-2803
US

V. Phone/Fax

Practice location:
  • Phone: 215-517-7777
  • Fax: 215-517-8180
Mailing address:
  • Phone: 215-718-6599
  • Fax: 215-517-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN000282
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000282
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: