Healthcare Provider Details

I. General information

NPI: 1821252248
Provider Name (Legal Business Name): LUISA SINISCALCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 AMORY ST
JAMAICA PLAIN MA
02130-2652
US

IV. Provider business mailing address

6 ELLIS ST
ROXBURY MA
02119-1407
US

V. Phone/Fax

Practice location:
  • Phone: 617-383-6522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1025
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: