Provider Demographics
NPI:1457902967
Name:BUGBEE, MICHELLE (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:BUGBEE
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 1:17 CONANT DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4517
Mailing Address - Country:US
Mailing Address - Phone:508-633-3178
Mailing Address - Fax:
Practice Address - Street 1:1492 HIGHLAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2606
Practice Address - Country:US
Practice Address - Phone:781-343-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4863133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered