Provider Demographics
NPI:1003375841
Name:BUSA, JESSE (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:JESSE
Middle Name:
Last Name:BUSA
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3293
Mailing Address - Country:US
Mailing Address - Phone:617-825-3400
Mailing Address - Fax:617-825-7217
Practice Address - Street 1:632 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-3293
Practice Address - Country:US
Practice Address - Phone:617-825-3400
Practice Address - Fax:617-825-7217
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4631-NU-NU133N00000X
86078381133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist