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NPI Code Detail

MEDICARE: YOUR WELLNESS CONSULTANTS

MEDICARE: YOUR WELLNESS CONSULTANTS
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
1133V00000XRegistered DietitianDN004701PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11508142696OTHERPANPI
21609167543OTHERPANPI

General Provider Information

NPI Number : 1750787610
Entity Type Code : Organization
Provider Name (Legal Business Name) : YOUR WELLNESS CONSULTANTS
Provider Business Mailing Address
First Line : 1 PRESIDENTIAL BLVD STE 203
Second Line :
City : BALA CYNWYD
State : PA
Zip : 19004-1007
Country : US
Telephone Number : 610-331-5439
Fax Number :
Provider Business Practice Location Address
First Line : 2835 TYSON AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-1415
Country : US
Telephone Number : 610-331-5439
Fax Number :
Authorized Official
Title or Position : PARTNER/REGISTERED DIETITIAN
Name : MS. DANIELLE DIMARCO
Credential : MS, RD, LDN, CPT
Telephone Number : 610-331-5439
Provider Enumeration Date : 11/05/2014
Last Update Date : 11/05/2014

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Directions to “YOUR WELLNESS CONSULTANTS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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