Healthcare Provider Details

I. General information

NPI: 1417091380
Provider Name (Legal Business Name): CHERYL ANN PELLAND-LAK R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 HIGH ST
GREENFIELD MA
01301-2613
US

IV. Provider business mailing address

31 FERRY ST
SOUTH HADLEY MA
01075-1041
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-2736
  • Fax:
Mailing address:
  • Phone: 413-536-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number942
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: