Provider Demographics
NPI:1225458995
Name:MASSAD, SUSAN (HSD, RD, CHES)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MASSAD
Suffix:
Gender:F
Credentials:HSD, RD, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 BOSTON POST RD
Mailing Address - Street 2:THE LONGFELLOW CLUB
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1833
Mailing Address - Country:US
Mailing Address - Phone:508-358-6022
Mailing Address - Fax:508-358-5976
Practice Address - Street 1:524 BOSTON POST RD.
Practice Address - Street 2:THE LONGFELLOW CLUB
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778
Practice Address - Country:US
Practice Address - Phone:508-358-6022
Practice Address - Fax:508-358-5976
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA380133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered