Provider Demographics
NPI:1457544058
Name:GOLDMAN, WENDY BROOKE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:BROOKE
Last Name:GOLDMAN
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 1:1516 CORSLEY CT
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3137
Mailing Address - Country:US
Mailing Address - Phone:215-628-0394
Mailing Address - Fax:
Practice Address - Street 1:930 TOWN CENTER DR
Practice Address - Street 2:SUITE G-100
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3503
Practice Address - Country:US
Practice Address - Phone:215-750-9831
Practice Address - Fax:215-750-9837
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1005X
PADN001347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered