=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730527581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUTRITION FOR HEALING, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2013
-----------------------------------------------------
Last Update Date | 06/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 JOHN MAHAR HIGHWAY 3RD FLOOR
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-291-3824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 334
-----------------------------------------------------
City | WEYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02188-0002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-291-3824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MERCY DEVADOSS
-----------------------------------------------------
Credential | MS, RD, LDN, CDE
-----------------------------------------------------
Telephone | 617-291-3824
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | LDN2144
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 922419
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------