Provider Demographics
NPI:1306353867
Name:BERSANI, VERONICA MARIE (MPH,RD,LDN)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:MARIE
Last Name:BERSANI
Suffix:
Gender:F
Credentials:MPH,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 TULIP ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2427
Mailing Address - Country:US
Mailing Address - Phone:267-939-4349
Mailing Address - Fax:
Practice Address - Street 1:1712 TULIP ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-2427
Practice Address - Country:US
Practice Address - Phone:267-939-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86026136133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered