Provider Demographics
NPI:1952019259
Name:ELMENDORF, KYRA (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:KYRA
Middle Name:
Last Name:ELMENDORF
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 1:6313 SUNNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1640
Mailing Address - Country:US
Mailing Address - Phone:570-730-2725
Mailing Address - Fax:
Practice Address - Street 1:808 BETHLEHEM PIKE STE 4
Practice Address - Street 2:
Practice Address - City:ERDENHEIM
Practice Address - State:PA
Practice Address - Zip Code:19038-8110
Practice Address - Country:US
Practice Address - Phone:570-730-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86291756133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered