1699720177 NPI number — MRS. BRENDA CHRISTINE SHILLING RD, LDN

Table of content: MRS. BRENDA CHRISTINE SHILLING RD, LDN (NPI 1699720177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699720177 NPI number — MRS. BRENDA CHRISTINE SHILLING RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHILLING
Provider First Name:
BRENDA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699720177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 LION ROAD
Provider Second Line Business Mailing Address:
PO BOX 788
Provider Business Mailing Address City Name:
CHERRY TREE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-743-6565
Provider Business Mailing Address Fax Number:
724-357-7414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 LION ROAD
Provider Second Line Business Practice Location Address:
DIETICIAN
Provider Business Practice Location Address City Name:
CHERRY TREE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-743-6565
Provider Business Practice Location Address Fax Number:
724-357-8046
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DN003463 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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