Mallory Smith Peterson, RD, LDN, CNSC, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

21901033 Issued in PA

Practice address

1648 Huntingdon Pike
Meadowbrook, PA 19046-8001

Phone

(215) 938-3392

NPI assigned

Mar 19, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1124654322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1648 HUNTINGDON PIKE",
            "city": "MEADOWBROOK",
            "state": "PA",
            "postal_code": "190468001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1648 HUNTINGDON PIKE",
            "city": "MEADOWBROOK",
            "state": "PA",
            "postal_code": "190468001",
            "telephone_number": "215-938-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MALLORY",
        "middle_name": "SMITH",
        "credential": "RD, LDN, CNSC, CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-19",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1101X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Gerontological",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "21901033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Pellecchia
• Edward J. Pellecchia, D.P.M.
• Penndios, LLC
• Andrew Perechocky, M.D.
• Frank C Pessler, MD
• Babak Salehi Pirouz, MD
• Perry S Pitkow, MD
• Ruby Pottukalam
• Kristen Pritch, CNIM
• Michelle C Quigel, CRNP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; 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.