Provider Demographics
NPI:1164812913
Name:GODINA, ANNE (MS RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:GODINA
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:PACETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 WOODVIEW WAY
Mailing Address - Street 2:UNIT 216
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4847
Mailing Address - Country:US
Mailing Address - Phone:630-631-8367
Mailing Address - Fax:
Practice Address - Street 1:300 WOODVIEW WAY
Practice Address - Street 2:UNIT 216
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4847
Practice Address - Country:US
Practice Address - Phone:630-631-8367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3583133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered