Provider Demographics
NPI:1578808853
Name:CERQUEIRA, PAULA DACOSTA (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:DACOSTA
Last Name:CERQUEIRA
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 1:32 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2620
Mailing Address - Country:US
Mailing Address - Phone:617-724-4000
Mailing Address - Fax:
Practice Address - Street 1:32 FRUIT ST
Practice Address - Street 2:YAWKEY 10B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2620
Practice Address - Country:US
Practice Address - Phone:617-724-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered