Provider Demographics
NPI:1821386418
Name:SOPATA, PAMELA MARIE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIE
Last Name:SOPATA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:350 BUDFIELD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3214
Mailing Address - Country:US
Mailing Address - Phone:814-266-9919
Mailing Address - Fax:814-266-0499
Practice Address - Street 1:350 BUDFIELD ST
Practice Address - Street 2:SUITE A
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3214
Practice Address - Country:US
Practice Address - Phone:814-266-9919
Practice Address - Fax:814-266-0499
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000319133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal