Provider Demographics
NPI:1528381555
Name:REVELIOTIS, PAULA FRANCES (MS,RD,LDN)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:FRANCES
Last Name:REVELIOTIS
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-2419
Mailing Address - Country:US
Mailing Address - Phone:617-241-5554
Mailing Address - Fax:
Practice Address - Street 1:122 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-2419
Practice Address - Country:US
Practice Address - Phone:617-241-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA774133V00000X
MAR418015133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered