Provider Demographics
NPI:1366708265
Name:PANNUCCI, MARIA C (RD)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:C
Last Name:PANNUCCI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:C
Other - Last Name:PANNUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3519 SILVERSIDE RD STE 200
Mailing Address - Street 2:CONCORD PLAZA, RIDGELY BUILDING
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4909
Mailing Address - Country:US
Mailing Address - Phone:302-543-5454
Mailing Address - Fax:302-327-4200
Practice Address - Street 1:3519 SILVERSIDE RD STE 200
Practice Address - Street 2:CONCORD PLAZA, RIDGELY BUILDING
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4909
Practice Address - Country:US
Practice Address - Phone:302-543-5454
Practice Address - Fax:302-327-4200
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN0000464133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered