MEDICARE: MRS. AMINA GRUNKO M.S., R.D., L.D.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1279	MA
2	133VN1004X	Pediatric Nutrition Registered Dietitian	1279	MA

General Provider Information

NPI Number	:	1790730356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMINA GRUNKO M.S., R.D., L.D.N.

Provider Business Mailing Address
First Line	:	53 RIVER ST
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-3535
Country	:	US
Telephone Number	:	781-643-0532
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 RIVER ST
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-3535
Country	:	US
Telephone Number	:	781-643-0532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/11/2025

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