Provider Demographics
NPI:1972345288
Name:DANIELS, CLARE (RD)
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:DANIELS
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 1:140 WOODHILL LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1963
Mailing Address - Country:US
Mailing Address - Phone:610-389-9601
Mailing Address - Fax:
Practice Address - Street 1:140 WOODHILL LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1963
Practice Address - Country:US
Practice Address - Phone:610-389-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004838133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered