Provider Demographics
NPI:1053862243
Name:DESANCTIS, CAROLINE MARIE (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:MARIE
Last Name:DESANCTIS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1013
Mailing Address - Country:US
Mailing Address - Phone:215-840-6310
Mailing Address - Fax:
Practice Address - Street 1:15000 MIDLANTIC DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1573
Practice Address - Country:US
Practice Address - Phone:800-736-3739
Practice Address - Fax:856-778-0636
Is Sole Proprietor?:No
Enumeration Date:2016-10-22
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04116163133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered