Provider Demographics
NPI:1184686099
Name:ROZANSKI, RAPHAELA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:RAPHAELA
Middle Name:
Last Name:ROZANSKI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1925
Mailing Address - Country:US
Mailing Address - Phone:508-533-8560
Mailing Address - Fax:508-533-7048
Practice Address - Street 1:115 HOLLISTON ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1954
Practice Address - Country:US
Practice Address - Phone:508-533-6634
Practice Address - Fax:508-533-7048
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA409133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMTO164Medicare ID - Type Unspecified
MALD0009Medicare UPIN