Most Relevant Information
Provider Data
| NPI Number: | 1003391277 |
| Provider Name: | SHOUK MANSOUR RD, CDCES |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/03/2018 |
| Last Updated: | 10/08/2020 |
Provider Practice Location
111 S FRONT ST
HARRISBURG
PA
171012010
Practice Location Phone/Fax
| Phone: | 7177823131 |
| Fax: |
Provider Mailing Location
111 S FRONT ST
HARRISBURG
PA
171012010
Provider Mailing Phone/Fax
| Phone: | 7177823131 |
| Fax: |