Provider Demographics
NPI:1003970112
Name:WOLFSON, SHEILA SUE (LDN)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:SUE
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GANNON TER
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6111
Mailing Address - Country:US
Mailing Address - Phone:508-875-3735
Mailing Address - Fax:508-875-3735
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4525
Practice Address - Country:US
Practice Address - Phone:508-875-3735
Practice Address - Fax:508-875-3735
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA701133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA1868OtherHARVARD PILGRIM
MA778778OtherTUFTS
MAMT0206Medicare ID - Type Unspecified