Provider Demographics
NPI:1699434589
Name:SCHMIDT, DEANNA M (RD, LDN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:M
Last Name:SCHMIDT
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 1:636 BENNER RD APT 103
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4633
Mailing Address - Country:US
Mailing Address - Phone:610-248-5260
Mailing Address - Fax:
Practice Address - Street 1:636 BENNER RD APT 103
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4633
Practice Address - Country:US
Practice Address - Phone:161-024-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001552133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered