Healthcare Provider Details

I. General information

NPI: 1699866251
Provider Name (Legal Business Name): SOPHIA CHEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOSLIN PL # 382A
BOSTON MA
02215-5306
US

IV. Provider business mailing address

1 JOSLIN PL # 382A
BOSTON MA
02215-5306
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-2699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: