Provider Demographics
NPI:1598491177
Name:SERGI, TINA ELIZABETH (MS, RD, CPT, LD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:ELIZABETH
Last Name:SERGI
Suffix:
Gender:F
Credentials:MS, RD, CPT, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MIFFLIN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3819
Mailing Address - Country:US
Mailing Address - Phone:978-314-8775
Mailing Address - Fax:
Practice Address - Street 1:8901 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-7403
Practice Address - Country:US
Practice Address - Phone:301-400-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1224133V00000X
MA5465-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered