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General NPI Number Information
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NPI Number | 1588739387
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Entity Type | Individual
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Provider Name | SUSAN G LELLIS RD
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 3130 STATE HIGHWAY ROUTE 6
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City | WELLFLEET
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State | MA
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Zip | 02667
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Country | US
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Telephone | 508-349-3131
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Fax | 508-349-1311
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Provider Business Mailing Address
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Address Line | PO BOX 1944
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City | NORTH EASTHAM
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State | MA
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Zip | 02651
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Country | US
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Telephone | 508-240-0208
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Fax | 508-240-0499
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2312
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License Number State | MA
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