Provider Demographics
NPI:1366687857
Name:SINCLAIR, KELLY BROOK (MS, RD, CDE, LD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BROOK
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:MS, RD, CDE, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6278
Mailing Address - Country:US
Mailing Address - Phone:978-521-3250
Mailing Address - Fax:978-469-5646
Practice Address - Street 1:1 PARKWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6278
Practice Address - Country:US
Practice Address - Phone:978-521-3250
Practice Address - Fax:978-469-5646
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2470133V00000X
MA2082133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered