Healthcare Provider Details

I. General information

NPI: 1053366849
Provider Name (Legal Business Name): PATRICIA ANNA VASCONCELLOS RD, CDE, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 FALMOUTH RD
MASHPEE MA
02649-2611
US

IV. Provider business mailing address

7 WALKERWOODS DR
EAST HARWICH MA
02645-2060
US

V. Phone/Fax

Practice location:
  • Phone: 508-246-1724
  • Fax: 508-432-8282
Mailing address:
  • Phone: 508-430-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number817115
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: