Healthcare Provider Details

I. General information

NPI: 1245153063
Provider Name (Legal Business Name): JANELLE ROSE MCCORMICK MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 BLOSSOM ST
BOSTON MA
02114-2601
US

IV. Provider business mailing address

51 BLOSSOM ST
BOSTON MA
02114-2601
US

V. Phone/Fax

Practice location:
  • Phone: 617-371-4734
  • Fax:
Mailing address:
  • Phone: 617-371-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN9091
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: