Provider Demographics
NPI:1730432774
Name:YEO, TRICIA LYNNE (DTR)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNNE
Last Name:YEO
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-1830
Mailing Address - Country:US
Mailing Address - Phone:609-471-0133
Mailing Address - Fax:
Practice Address - Street 1:151 FRIES MILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-302-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1066521136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered