Provider Demographics
NPI:1396934212
Name:PASKEVICH, RANDI JO (MED, RD, LDN)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:JO
Last Name:PASKEVICH
Suffix:
Gender:F
Credentials:MED, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7317 COBBLE STONE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9038
Mailing Address - Country:US
Mailing Address - Phone:717-712-8225
Mailing Address - Fax:
Practice Address - Street 1:7317 COBBLE STONE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9038
Practice Address - Country:US
Practice Address - Phone:717-712-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003810133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033319210001Medicaid