MEDICARE: AFAF SAAB KHADDAJE MS,RD

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	133V00000X	Registered Dietitian	4955	MA
2	133V00000X	Registered Dietitian	LDN4955	MA

General Provider Information

NPI Number	:	1477172450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFAF SAAB KHADDAJE MS,RD

Provider Business Mailing Address
First Line	:	251 HIGH ST
Second Line	:
City	:	WINCHESTER
State	:	MA
Zip	:	01890-3247
Country	:	US
Telephone Number	:	617-447-7660
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 MIDDLESEX TPKE STE 3110
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-5380
Country	:	US
Telephone Number	:	781-744-1066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2020
Last Update Date	:	10/31/2024

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