MEDICARE: ASHLEY SAKENAS RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DN004890	PA

General Provider Information

NPI Number	:	1023365376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SAKENAS RD

Provider Business Mailing Address
First Line	:	2321 E BOSTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 SOUTH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1636
Country	:	US
Telephone Number	:	215-559-1019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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