Provider Demographics
NPI:1700209038
Name:ROSEN, MARY SHEA (RD,MS,LDN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:SHEA
Last Name:ROSEN
Suffix:
Gender:F
Credentials:RD,MS,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 GUILFORD ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6401
Mailing Address - Country:US
Mailing Address - Phone:802-257-9566
Mailing Address - Fax:802-257-9566
Practice Address - Street 1:449 GUILFORD ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6401
Practice Address - Country:US
Practice Address - Phone:802-257-9566
Practice Address - Fax:802-257-9566
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILR422803133NN1002X, 133V00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator