Healthcare Provider Details

I. General information

NPI: 1285075333
Provider Name (Legal Business Name): AMIRA Y PELLETT PHD, RD, LDN,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIRA Y SROUJI MS

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SOUTH PROSPECT STREET SUITE NO. 9 VALLEY NUTRITION COUNSELLING,
AMHERST MA
01002
US

IV. Provider business mailing address

26 SOUTH PROSPECT STREET SUITE NO. 9 VALLEY NUTRITION COUNSELLING
AMHERST MA
01002
US

V. Phone/Fax

Practice location:
  • Phone: 413-314-3438
  • Fax:
Mailing address:
  • Phone: 413-314-3438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number740
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: