Provider Demographics
NPI:1053366849
Name:VASCONCELLOS, PATRICIA ANNA (RD, CDE, LDN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNA
Last Name:VASCONCELLOS
Suffix:
Gender:F
Credentials:RD, CDE, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WALKERWOODS DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2060
Mailing Address - Country:US
Mailing Address - Phone:508-430-4461
Mailing Address - Fax:
Practice Address - Street 1:133 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-2611
Practice Address - Country:US
Practice Address - Phone:508-246-1724
Practice Address - Fax:508-432-8282
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA817115133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0077Medicare ID - Type UnspecifiedMEDICARE B