Healthcare Provider Details

I. General information

NPI: 1477819845
Provider Name (Legal Business Name): SUSAN A OLIVEIRA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROSEBROOK WAY 3RD FLOOR
WAREHAM MA
02571-1007
US

IV. Provider business mailing address

200 MILL ROAD SUITE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-273-4900
  • Fax: 508-273-4901
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3300
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: