Provider Demographics
NPI:1598283244
Name:IACONO, STEFANIA (RD)
Entity type:Individual
Prefix:
First Name:STEFANIA
Middle Name:
Last Name:IACONO
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 1:45 CREEKSIDE LN UNIT 334
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3272
Mailing Address - Country:US
Mailing Address - Phone:484-574-6852
Mailing Address - Fax:
Practice Address - Street 1:2515 AVON RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-3012
Practice Address - Country:US
Practice Address - Phone:484-574-6852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered