Provider Demographics
NPI:1023491016
Name:CHELSVIG, GORDANA (RD, LDN)
Entity type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:CHELSVIG
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 1:308 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2001
Mailing Address - Country:US
Mailing Address - Phone:610-667-1588
Mailing Address - Fax:610-667-3699
Practice Address - Street 1:112 BALA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3025
Practice Address - Country:US
Practice Address - Phone:610-667-1588
Practice Address - Fax:610-667-3699
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002907133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered