Provider Demographics
NPI:1336617190
Name:DAULERIO, GINA NICOLE (RDN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:NICOLE
Last Name:DAULERIO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9981 HARDY RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1701
Mailing Address - Country:US
Mailing Address - Phone:267-455-6370
Mailing Address - Fax:
Practice Address - Street 1:9981 HARDY RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1701
Practice Address - Country:US
Practice Address - Phone:267-455-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86101426133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered