Healthcare Provider Details

I. General information

NPI: 1407230386
Provider Name (Legal Business Name): ALYSHA GEBO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PEMBROKE AVE
ACUSHNET MA
02743-2346
US

IV. Provider business mailing address

736 CAMBRIDGE ST
CAMBRIDGE MA
02141-1401
US

V. Phone/Fax

Practice location:
  • Phone: 508-688-4794
  • Fax: 508-974-9849
Mailing address:
  • Phone: 617-789-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: