Healthcare Provider Details

I. General information

NPI: 1558235119
Provider Name (Legal Business Name): CHRISTINA YEADON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PINEWOOD RD
TEWKSBURY MA
01876-2054
US

IV. Provider business mailing address

6 PINEWOOD RD
TEWKSBURY MA
01876-2054
US

V. Phone/Fax

Practice location:
  • Phone: 781-710-4486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN00855
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number86052470
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN3840
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: