Basic Information
| Provider Information | |||||||||
| NPI: | 1952371643 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DACUNHA | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | RD LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 BARTLETT RD | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819612023 | ||||||||
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| Practice Location | |||||||||
| Address1: | 398 NEPONSET AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172823200 | ||||||||
| FaxNumber: | 6172827928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 2070 | MA | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.