Provider Demographics
NPI:1538381082
Name:SCOTT, ANGELA GRASSI (LDN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GRASSI
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:GRASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1440 RUSSELL ROAD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:610-644-6464
Mailing Address - Fax:610-644-4066
Practice Address - Street 1:1440 RUSSELL ROAD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:610-644-4066
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001294133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist