Provider Demographics
NPI:1205377157
Name:SALGADO, ILENE (RD)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:
Last Name:SALGADO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 BOYD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2706
Mailing Address - Country:US
Mailing Address - Phone:508-439-1700
Mailing Address - Fax:
Practice Address - Street 1:37B OAK ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-4722
Practice Address - Country:US
Practice Address - Phone:508-439-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-12
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA991694133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered