Provider Demographics
NPI:1396119517
Name:MANISCALCO, SHELLEY (MPH RD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:MANISCALCO
Suffix:
Gender:F
Credentials:MPH RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 N EDISON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1935
Mailing Address - Country:US
Mailing Address - Phone:703-909-5885
Mailing Address - Fax:
Practice Address - Street 1:1727 N EDISON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1935
Practice Address - Country:US
Practice Address - Phone:703-909-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered