Provider Demographics
NPI:1912220336
Name:SOUCY, IRENE M (RD)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:M
Last Name:SOUCY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 AUGUSTINE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-2214
Mailing Address - Country:US
Mailing Address - Phone:302-753-0560
Mailing Address - Fax:302-376-7190
Practice Address - Street 1:600 N BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1032
Practice Address - Country:US
Practice Address - Phone:302-376-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20100312122133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal