Healthcare Provider Details

I. General information

NPI: 1841164373
Provider Name (Legal Business Name): SHENNA TYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 LAUREL AVE
LEE MA
01238-1208
US

IV. Provider business mailing address

42 LAUREL AVE
LEE MA
01238-1208
US

V. Phone/Fax

Practice location:
  • Phone: 413-281-2205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN8003
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: