Healthcare Provider Details

I. General information

NPI: 1356494173
Provider Name (Legal Business Name): LELA SILVERSTEIN LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

IV. Provider business mailing address

47 OAKRIDGE ST
BOSTON MA
02126-2811
US

V. Phone/Fax

Practice location:
  • Phone: 617-425-2040
  • Fax: 617-425-2040
Mailing address:
  • Phone: 617-425-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number692
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: