Healthcare Provider Details

I. General information

NPI: 1518564582
Provider Name (Legal Business Name): LUCIANA AMBROSI SLEIGHT MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCIANA AMBROSI MS RD

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTA CRUZ
RADA TILLY CHUBUT
09001
AR

IV. Provider business mailing address

2 INVERNESS LN
PLYMOUTH MA
02360-3176
US

V. Phone/Fax

Practice location:
  • Phone: 617-982-2339
  • Fax:
Mailing address:
  • Phone: 617-982-2338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: