MEDICARE: KRISTY DEL CORO MS, RDN

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	133N00000X	Nutritionist	48 006579	NY
2	133V00000X	Registered Dietitian	00978064

General Provider Information

NPI Number	:	1154616365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY DEL CORO MS, RDN

Provider Business Mailing Address
First Line	:	165 WALNUT HILL RD
Second Line	:
City	:	NORTH YARMOUTH
State	:	ME
Zip	:	04097-6507
Country	:	US
Telephone Number	:	410-430-0730
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 WALNUT HILL RD
Second Line	:
City	:	NORTH YARMOUTH
State	:	ME
Zip	:	04097-6507
Country	:	US
Telephone Number	:	410-430-0730
Fax Number	:

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	12/29/2020

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