Provider Demographics
NPI:1508226978
Name:WELCH, ALEXANDRA (MA RD LDN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MA RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-3121
Mailing Address - Country:US
Mailing Address - Phone:508-865-1819
Mailing Address - Fax:
Practice Address - Street 1:3 WILDFLOWER DR
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:MA
Practice Address - Zip Code:01590-3121
Practice Address - Country:US
Practice Address - Phone:508-865-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4066133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered