Provider Demographics
NPI:1205653185
Name:HUMBERD, JANAELLE DEAMATO (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:JANAELLE
Middle Name:DEAMATO
Last Name:HUMBERD
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 FRANKLIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1653
Mailing Address - Country:US
Mailing Address - Phone:617-957-1061
Mailing Address - Fax:
Practice Address - Street 1:891 FRANKLIN ST APT 1
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-1653
Practice Address - Country:US
Practice Address - Phone:617-957-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2566133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered