Provider Demographics
NPI:1861878662
Name:PORRAZZA, FELICIA (MDA, RDN, LDN, CPT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:PORRAZZA
Suffix:
Gender:F
Credentials:MDA, RDN, LDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 EAST LINCOLN HIGHWAY
Mailing Address - Street 2:#216
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2213
Mailing Address - Country:US
Mailing Address - Phone:215-821-7045
Mailing Address - Fax:610-200-5782
Practice Address - Street 1:601 WARWICK RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-821-7045
Practice Address - Fax:610-200-5782
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005379133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered