MEDICARE: BLUEPRINT NUTRITION LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1346108669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEPRINT NUTRITION LLP

Provider Business Mailing Address
First Line	:	66 MYSTIC ST APT 3
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-1142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 BUSINESS ST STE A
Second Line	:
City	:	HYDE PARK
State	:	MA
Zip	:	02136-2126
Country	:	US
Telephone Number	:	617-468-8371
Fax Number	:	329-212-6727

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	ROWAN BISHOP
Credential	:	RD, LDN
Telephone Number	:	413-801-2629

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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