Provider Demographics
NPI:1831933969
Name:MIX, MICHELLE SUZANNE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:MIX
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 1:6 NEBO ST
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2201
Mailing Address - Country:US
Mailing Address - Phone:339-225-0592
Mailing Address - Fax:
Practice Address - Street 1:6 NEBO ST
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2201
Practice Address - Country:US
Practice Address - Phone:339-225-0592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty