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General NPI Number Information
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NPI Number | 1609475391
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Entity Type | Individual
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Provider Name | KACY ROMEO DISANTILLO
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Gender | Female
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 2000 SHORE RD STE 104
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City | LINWOOD
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State | NJ
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Zip | 08221-2100
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Country | US
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Telephone | 609-904-5627
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Fax |
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Provider Business Mailing Address
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Address Line | 94 SUNSET DR
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City | MOUNT ROYAL
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State | NJ
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Zip | 08061-1016
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Country | US
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Telephone | 856-534-2935
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Fax |
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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