Provider Demographics
NPI:1619528072
Name:WELLMAN, LINDSAY (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 SPRINGS RD
Mailing Address - Street 2:120, NUTRITION DEPARTMENT
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1198
Mailing Address - Country:US
Mailing Address - Phone:781-687-2454
Mailing Address - Fax:781-687-4440
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4617-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1084616OtherACADEMY OF NUTRITION AND DIETETICS
MA4617-NUOtherMASSACHUSETTS BOARD OF REGISTRATION OF DIETITIANS AND NUTRITIONISTS