Provider Demographics
NPI:1063873818
Name:SHRINER, KELSEY (RDN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SHRINER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:SHRINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:475 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3918
Mailing Address - Country:US
Mailing Address - Phone:215-482-5353
Mailing Address - Fax:
Practice Address - Street 1:475 SPRING LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3918
Practice Address - Country:US
Practice Address - Phone:215-482-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3433213133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered