Provider Demographics
NPI:1457119539
Name:DEBIASSE, MICHELE ANN (PHD, RDN, LDN)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ANN
Last Name:DEBIASSE
Suffix:
Gender:F
Credentials:PHD, RDN, LDN
Other - Prefix:DR
Other - First Name:SHELLY
Other - Middle Name:ANN
Other - Last Name:DEBIASSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, RDN, LDN
Mailing Address - Street 1:12 SUMMER HILL RD
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-1547
Mailing Address - Country:US
Mailing Address - Phone:617-688-2677
Mailing Address - Fax:
Practice Address - Street 1:2557 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1020
Practice Address - Country:US
Practice Address - Phone:617-744-9233
Practice Address - Fax:617-300-8910
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN7312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered