Provider Demographics
NPI:1649467499
Name:SEALS, CRYSTAL RENEA (RD, LDN CDE)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:RENEA
Last Name:SEALS
Suffix:
Gender:F
Credentials:RD, LDN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W HORTTER ST
Mailing Address - Street 2:A1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3654
Mailing Address - Country:US
Mailing Address - Phone:267-297-6251
Mailing Address - Fax:
Practice Address - Street 1:714 N BETHLEHEM PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2655
Practice Address - Country:US
Practice Address - Phone:215-283-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003599133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered