Provider Demographics
NPI:1265825046
Name:FIERRAS, KELLILYN ROSE (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:KELLILYN
Middle Name:ROSE
Last Name:FIERRAS
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 1:158 NEPONSET AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3341
Mailing Address - Country:US
Mailing Address - Phone:610-724-2888
Mailing Address - Fax:
Practice Address - Street 1:158 NEPONSET AVE
Practice Address - Street 2:APT 1
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3341
Practice Address - Country:US
Practice Address - Phone:610-724-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered