Provider Demographics
NPI:1902382054
Name:GOSSELIN, SOPHIE NADINE (MS, RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:SOPHIE
Middle Name:NADINE
Last Name:GOSSELIN
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 1:125 PARKER HILL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2865
Mailing Address - Country:US
Mailing Address - Phone:617-754-5351
Mailing Address - Fax:617-754-5918
Practice Address - Street 1:125 PARKER HILL AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-2865
Practice Address - Country:US
Practice Address - Phone:617-754-5351
Practice Address - Fax:617-754-5918
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4274133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered