Healthcare Provider Details

I. General information

NPI: 1750615548
Provider Name (Legal Business Name): CATHERINE ELIZABETH SILVA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 NORTH AVE DOOR 12
WAKEFIELD MA
01880-2310
US

IV. Provider business mailing address

166 WOBURN ST UNIT 1
READING MA
01867-3560
US

V. Phone/Fax

Practice location:
  • Phone: 781-799-5644
  • Fax:
Mailing address:
  • Phone: 781-799-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number85
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number85
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number85
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: