Provider Demographics
NPI:1730286352
Name:GALLANT, MICHELLE PHYLLIS (MS, RDN, LDN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:PHYLLIS
Last Name:GALLANT
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MOUNT AUBURN ST
Mailing Address - Street 2:HARVARD UNIVERSITY HEALTH SERVICES
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4960
Mailing Address - Country:US
Mailing Address - Phone:617-495-1487
Mailing Address - Fax:617-496-0540
Practice Address - Street 1:75 MOUNT AUBURN ST
Practice Address - Street 2:HARVARD UNIVERSITY HEALTH SERVICES
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4960
Practice Address - Country:US
Practice Address - Phone:617-495-1487
Practice Address - Fax:617-496-0540
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2777133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000784601Medicare PIN