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General NPI Number Information
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NPI Number | 1538652011
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Entity Type | Individual
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Provider Name | MELISSA VISCUSO RD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1101 CHESTNUT ST
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City | PHILA
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State | PA
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Zip | 19107-3612
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Country | US
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Telephone | 215-955-8900
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Fax | 215-923-3447
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Provider Business Mailing Address
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Address Line | 132 SOUTH 10TH STREET 480 MAIN BUILDING
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City | PHILA
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State | PA
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Zip | 19107-5244
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Country | US
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Telephone | 215-955-8900
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Fax | 215-923-3447
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DN004726
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License Number State | PA
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