Provider Demographics
NPI:1437232147
Name:CRUPI- SULLIVAN, KATIE N (RD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:N
Last Name:CRUPI- SULLIVAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:N
Other - Last Name:CRUPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:210 JONES RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2974
Mailing Address - Country:US
Mailing Address - Phone:508-299-8202
Mailing Address - Fax:508-299-8355
Practice Address - Street 1:210 JONES RD
Practice Address - Street 2:SUITE 11
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2974
Practice Address - Country:US
Practice Address - Phone:508-299-8202
Practice Address - Fax:508-299-8355
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2363133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2363OtherMASSACHUSETSS LICENSE