Provider Demographics
NPI:1407175458
Name:YEMMA, TRACY A (MS, RD, LDN, CPT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:A
Last Name:YEMMA
Suffix:
Gender:F
Credentials:MS, RD, LDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 AUSTIN ST # 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3501
Mailing Address - Country:US
Mailing Address - Phone:617-308-8254
Mailing Address - Fax:
Practice Address - Street 1:8 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-3501
Practice Address - Country:US
Practice Address - Phone:617-308-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA979133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education