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General NPI Number Information
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NPI Number | 1487909362
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Entity Type | Individual
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Provider Name | MERCY DEVADOSS MS, RD, LDN, CDE
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 501 JOHN MAHAR HWY - 3RD FLOOR
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City | BRAINTREE
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State | MA
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Zip | 02184
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Country | US
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Telephone | 617-291-3824
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX -334
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City | WEYMOUTH
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State | MA
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Zip | 02188-0002
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Country | US
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Telephone | 617-291-3824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | LDN#2144
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 922419/2144
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License Number State | MA
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