Provider Demographics
NPI:1386109700
Name:SMALL-KINCHEN, SALIMA V
Entity type:Individual
Prefix:
First Name:SALIMA
Middle Name:V
Last Name:SMALL-KINCHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 SHARON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-2219
Mailing Address - Country:US
Mailing Address - Phone:856-300-3888
Mailing Address - Fax:
Practice Address - Street 1:1437 SHARON PARK DR
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-2219
Practice Address - Country:US
Practice Address - Phone:856-300-3888
Practice Address - Fax:215-689-0807
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
958585133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist