Healthcare Provider Details

I. General information

NPI: 1013762574
Provider Name (Legal Business Name): NADINE TASSABEHJI RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 LOWELL ST
LEXINGTON MA
02420-2240
US

IV. Provider business mailing address

1 KNEELAND ST
BOSTON MA
02111-1527
US

V. Phone/Fax

Practice location:
  • Phone: 850-339-7821
  • Fax:
Mailing address:
  • Phone: 617-636-0467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberLDN4675
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN4675
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: