MEDICARE: ADELIA CLARKE

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

General Provider Information

NPI Number	:	1508171836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELIA CLARKE

Provider Business Mailing Address
First Line	:	11832 233RD ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-2228
Country	:	US
Telephone Number	:	718-949-6825
Fax Number	:

Provider Business Practice Location Address
First Line	:	11832 233RD ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-2228
Country	:	US
Telephone Number	:	718-949-6825
Fax Number	:

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

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	08/11/2010

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Directions to “ ADELIA CLARKE ” Practice Location

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