Provider Demographics
NPI:1245830272
Name:COMEAU, ALYSON MARIE (RDN)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:MARIE
Last Name:COMEAU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LAKE DR W
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1409
Mailing Address - Country:US
Mailing Address - Phone:978-846-6164
Mailing Address - Fax:
Practice Address - Street 1:418 PATRIOTS RD STE A
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:MA
Practice Address - Zip Code:01468-1614
Practice Address - Country:US
Practice Address - Phone:978-846-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5202133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist