MEDICARE: GRACE MCKELVEY 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	133V00000X	Registered Dietitian		PA

General Provider Information

NPI Number	:	1588509269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE MCKELVEY RDN

Provider Business Mailing Address
First Line	:	619 BRECKNOCK DR
Second Line	:
City	:	EXTON
State	:	PA
Zip	:	19341-1913
Country	:	US
Telephone Number	:	484-467-2467
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 W CHESTER PIKE APT F28
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-5085
Country	:	US
Telephone Number	:	484-467-2467
Fax Number	:

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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