Healthcare Provider Details

I. General information

NPI: 1982812889
Provider Name (Legal Business Name): KATHERINE TSAIOUN PH.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 RT 6A SUITE 2A
ORLEANS MA
02653-2409
US

IV. Provider business mailing address

83 NEWBURG ST #2
ROSLINDALE MA
02131-2825
US

V. Phone/Fax

Practice location:
  • Phone: 508-812-0850
  • Fax:
Mailing address:
  • Phone: 508-812-0850
  • Fax: 617-812-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1815
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: