Healthcare Provider Details

I. General information

NPI: 1053615062
Provider Name (Legal Business Name): METROWEST NUTRITION AND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EDGELL RD STE 39
FRAMINGHAM MA
01701-4868
US

IV. Provider business mailing address

5 EDGELL RD STE 39
FRAMINGHAM MA
01701-4868
US

V. Phone/Fax

Practice location:
  • Phone: 617-332-2282
  • Fax: 508-302-0507
Mailing address:
  • Phone: 617-332-2282
  • Fax: 508-302-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2055
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMY GLEASON GARDNER
Title or Position: OWNER
Credential:
Phone: 617-332-2282