Provider Demographics
NPI:1689234965
Name:MOSHER, MARSHA ANN (RDN,CDN)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:ANN
Last Name:MOSHER
Suffix:
Gender:F
Credentials:RDN,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2040
Mailing Address - Country:US
Mailing Address - Phone:315-464-5726
Mailing Address - Fax:
Practice Address - Street 1:3229 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2040
Practice Address - Country:US
Practice Address - Phone:315-464-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1070603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered