Provider Demographics
NPI:1417336496
Name:RICCARDO, CHRISTINA (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:RICCARDO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 MAPLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1449
Mailing Address - Country:US
Mailing Address - Phone:215-962-8849
Mailing Address - Fax:
Practice Address - Street 1:829 SECOND STREET PIKE FL 1
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1067
Practice Address - Country:US
Practice Address - Phone:267-907-8350
Practice Address - Fax:215-860-2266
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA61Q96013133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered