Healthcare Provider Details

I. General information

NPI: 1770090466
Provider Name (Legal Business Name): LEXINGTON NUTRITION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 WOBURN ST
LEXINGTON MA
02420-2326
US

IV. Provider business mailing address

390 WOBURN ST
LEXINGTON MA
02420-2326
US

V. Phone/Fax

Practice location:
  • Phone: 781-330-9928
  • Fax: 781-330-9928
Mailing address:
  • Phone: 781-330-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: SHALINI CHALANA
Title or Position: OWNER
Credential: RD
Phone: 781-330-9928