Basic Information
| Provider Information | |||||||||
| NPI: | 1528208709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLATTERY | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RD, LDN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ATTARD | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | A. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 280 CHESTNUT STREET | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137949999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 759 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137944954 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2009 | ||||||||
| LastUpdateDate: | 07/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 2843 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.