Provider Demographics
NPI:1215371000
Name:NIETO, ZEINA DALU (MD)
Entity Type:Individual
Prefix:
First Name:ZEINA
Middle Name:DALU
Last Name:NIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZEINA
Other - Middle Name:
Other - Last Name:DALU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 WELLNESS WAY BLDG 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9706
Mailing Address - Country:US
Mailing Address - Phone:724-250-6001
Mailing Address - Fax:
Practice Address - Street 1:100 WELLNESS WAY BLDG 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9706
Practice Address - Country:US
Practice Address - Phone:724-250-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460714208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015918490027Medicaid