Provider Demographics
NPI:1730255969
Name:SULAVA, MARY FRANCES
Entity type:Individual
Prefix:
First Name:MARY FRANCES
Middle Name:
Last Name:SULAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PARKVIEW DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7105
Mailing Address - Country:US
Mailing Address - Phone:844-328-9473
Mailing Address - Fax:724-545-7233
Practice Address - Street 1:104 PARKVIEW DR
Practice Address - Street 2:SUITE 1
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7105
Practice Address - Country:US
Practice Address - Phone:844-328-9473
Practice Address - Fax:724-545-7233
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001214133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist