Provider Demographics
NPI:1275812174
Name:DEPAULA, BRITTANY ELIZABETH (RD)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:ELIZABETH
Last Name:DEPAULA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:ELIZABETH
Other - Last Name:TELLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6177
Mailing Address - Fax:617-730-4722
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6177
Practice Address - Fax:617-730-4722
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3060133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200445Medicaid