Philly Dietitian LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DN004553 Issued in PA

Legal business name

PHILLY DIETITIAN LLC

Practice address

1909 Green St
Philadelphia, PA 19130-3244

Phone

(717) 203-9728

NPI assigned

Nov 2, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Theresa Elizabeth Shank

Title

Registered Dietitian

Phone

(717) 203-9728

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446422400000",
    "number": "1114390085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 GREEN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191303244",
            "telephone_number": "717-203-9728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 GREEN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191303244",
            "telephone_number": "717-203-9728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLY DIETITIAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-02",
        "last_updated": "2015-11-02",
        "status": "A",
        "authorized_official_last_name": "SHANK",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "717-203-9728",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN004553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Phillips
• Sheneiah Phillips
• Tara Mulvey Phillips, CRNP
• Philly ABA Therapy LLC
• Philly As, LLC
• Philly Drugstore LLC
• Philly Family Life Counseling, LLC
• Philly Ifs Therapy, LLC
• Philly Injury Center, Inc.
• Philly Kids 'N Nurses

• Registered Dietitian in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.