Provider Demographics
NPI:1467885483
Name:D'ELIA, MARY KAY A (RDN, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:MARY KAY
Middle Name:A
Last Name:D'ELIA
Suffix:
Gender:F
Credentials:RDN, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PEACHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7262
Mailing Address - Country:US
Mailing Address - Phone:570-237-5758
Mailing Address - Fax:
Practice Address - Street 1:425 ALDER ST UNIT 2
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505
Practice Address - Country:US
Practice Address - Phone:570-880-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001083133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019462370005Medicaid
PA0019462370004Medicaid
PA1007678420040Medicaid
PA0019462370001Medicaid
PA1007678420041Medicaid
PA1007678420042Medicaid