MEDICARE: JENNIFER ANNE MASELLO MS, RD, LDN

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	ND14747	FL

General Provider Information

NPI Number	:	1932068525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANNE MASELLO MS, RD, LDN

Provider Business Mailing Address
First Line	:	52 N ST
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-4518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 N ST
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-4518
Country	:	US
Telephone Number	:	630-841-8113
Fax Number	:

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

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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