MEDICARE: ASHLEY ELIZABETH MAYES 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	DN006498	PA

General Provider Information

NPI Number	:	1881185510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ELIZABETH MAYES RD

Provider Business Mailing Address
First Line	:	300 BROOKSIDE AVE STE 180
Second Line	:
City	:	AMBLER
State	:	PA
Zip	:	19002-3436
Country	:	US
Telephone Number	:	877-842-2425
Fax Number	:	484-930-0063

Provider Business Practice Location Address
First Line	:	300 BROOKSIDE AVE STE 180
Second Line	:
City	:	AMBLER
State	:	PA
Zip	:	19002-3436
Country	:	US
Telephone Number	:	877-842-2425
Fax Number	:	484-930-0063

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	04/06/2022

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