Provider Demographics
NPI:1801153481
Name:STEFANKIEWICZ, PATRICIA (RD, LDN CNSC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:STEFANKIEWICZ
Suffix:
Gender:F
Credentials:RD, LDN CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1415
Mailing Address - Country:US
Mailing Address - Phone:610-812-9370
Mailing Address - Fax:
Practice Address - Street 1:419 S 19TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1415
Practice Address - Country:US
Practice Address - Phone:610-812-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered