Healthcare Provider Details

I. General information

NPI: 1013728229
Provider Name (Legal Business Name): VITAL STARTS NUTRITION AND LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 PROCTOR CIR
PEABODY MA
01960-2822
US

IV. Provider business mailing address

38 PROCTOR CIR
PEABODY MA
01960-2822
US

V. Phone/Fax

Practice location:
  • Phone: 401-451-5684
  • Fax:
Mailing address:
  • Phone: 401-451-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: IRENE TERENZONI
Title or Position: OWNER
Credential: RD, IBCLC
Phone: 401-451-5684