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General NPI Number Information
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NPI Number | 1821730862
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Entity Type | Organization
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Legal Business Name | MELISSA LANDRY NUTRITION LLC
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 37 FAIRVIEW ST # 1
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City | ROSLINDALE
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State | MA
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Zip | 02131-1627
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Country | US
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Telephone | 617-842-4118
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Fax |
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Provider Business Mailing Address
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Address Line | 37 FAIRVIEW ST # 1
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City | ROSLINDALE
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State | MA
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Zip | 02131-1627
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Country | US
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Telephone | 617-842-4118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA LANDRY
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Credential | RD LDN
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Telephone | 617-842-4118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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