Provider Demographics
NPI:1841245198
Name:SEDLACKO, ANGELA DARIA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DARIA
Last Name:SEDLACKO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 POST DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2653
Mailing Address - Country:US
Mailing Address - Phone:724-832-8061
Mailing Address - Fax:724-832-9311
Practice Address - Street 1:FMC MEDICAL SERVICES OF GREENSBURG CKD SERVICES
Practice Address - Street 2:562 SHEARER ST.
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-832-8061
Practice Address - Fax:724-832-9311
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002175133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
083267ETDMedicare UPIN