Provider Demographics
NPI:1841677291
Name:FORNASARO-DONAHUE, VIVIANE MARIA (MS, RD)
Entity type:Individual
Prefix:
First Name:VIVIANE
Middle Name:MARIA
Last Name:FORNASARO-DONAHUE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 OLDE TOWER LN
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-3955
Mailing Address - Country:US
Mailing Address - Phone:617-388-5307
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE ST STE 8025
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-779-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00992133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered