Healthcare Provider Details

I. General information

NPI: 1356416515
Provider Name (Legal Business Name): PAMELA RAND RD, LDN, CDOE, RYT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 KINGSTOWN RD UNIT 3
PEACE DALE RI
02879-7902
US

IV. Provider business mailing address

1167 KINGSTOWN RD UNIT 3
PEACE DALE RI
02879-7902
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-4003
  • Fax: 401-783-4428
Mailing address:
  • Phone: 401-295-4003
  • Fax: 401-783-4428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number51
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: