Healthcare Provider Details

I. General information

NPI: 1316734098
Provider Name (Legal Business Name): SOPHIA PATRICIA GRIFFIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA PATRICIA GRIFFIN RD, LDN

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 S MAIN ST
MANCHESTER NH
03102-5166
US

IV. Provider business mailing address

10 TRENTON ST
METHUEN MA
01844-1576
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-7377
  • Fax:
Mailing address:
  • Phone: 978-305-8191
  • Fax: 978-305-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1896
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: