Provider Demographics
NPI:1255925228
Name:PRESBERY, MILADIS (IBCLC)
Entity type:Individual
Prefix:
First Name:MILADIS
Middle Name:
Last Name:PRESBERY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 SAINT VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1624
Mailing Address - Country:US
Mailing Address - Phone:267-736-9636
Mailing Address - Fax:
Practice Address - Street 1:3340 SAINT VINCENT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1624
Practice Address - Country:US
Practice Address - Phone:267-736-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA302097174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN