Healthcare Provider Details

I. General information

NPI: 1184686099
Provider Name (Legal Business Name): RAPHAELA ROZANSKI RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HOLLISTON ST
MEDWAY MA
02053-1954
US

IV. Provider business mailing address

5 VIRGINIA RD
MEDWAY MA
02053-1925
US

V. Phone/Fax

Practice location:
  • Phone: 508-533-6634
  • Fax: 508-533-7048
Mailing address:
  • Phone: 508-533-8560
  • Fax: 508-533-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number409
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: