Provider Demographics
NPI:1851640486
Name:SOTEROPOULOS, ISMINI (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:ISMINI
Middle Name:
Last Name:SOTEROPOULOS
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 1:39 BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1165
Mailing Address - Country:US
Mailing Address - Phone:978-335-9719
Mailing Address - Fax:
Practice Address - Street 1:39 BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-1165
Practice Address - Country:US
Practice Address - Phone:978-335-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3081133V00000X
133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered