Provider Demographics
NPI:1518232347
Name:BALAFOUTAS, MAURA BETH (CSR, RD, LDN)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:BETH
Last Name:BALAFOUTAS
Suffix:
Gender:F
Credentials:CSR, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-2168
Mailing Address - Country:US
Mailing Address - Phone:717-658-4540
Mailing Address - Fax:
Practice Address - Street 1:421 SCOTT DR
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-2168
Practice Address - Country:US
Practice Address - Phone:717-658-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND13996133V00000X
PADN003817133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3482223OtherHIGHMARK BLUE SHIELD
PA662611Medicaid