Provider Demographics
NPI:1558982827
Name:MASTRANGELO, CHRISTINE LYN PARADISE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LYN PARADISE
Last Name:MASTRANGELO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:PARADISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 QUAIL RUN HOLW
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4508
Mailing Address - Country:US
Mailing Address - Phone:781-248-8238
Mailing Address - Fax:
Practice Address - Street 1:4 QUAIL RUN HOLW
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-4508
Practice Address - Country:US
Practice Address - Phone:781-248-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA813212133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered