Provider Demographics
NPI:1982867545
Name:MOORADIAN, TERESA ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
Last Name:MOORADIAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:FISCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:136 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1842
Mailing Address - Country:US
Mailing Address - Phone:814-453-7661
Mailing Address - Fax:814-455-1132
Practice Address - Street 1:136 EAST AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1842
Practice Address - Country:US
Practice Address - Phone:814-453-7661
Practice Address - Fax:814-455-1132
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002711133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered