Provider Demographics
NPI:1912233503
Name:ROMAIN, ROYLETTA (MED, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ROYLETTA
Middle Name:
Last Name:ROMAIN
Suffix:
Gender:F
Credentials:MED, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WOODROW AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3264
Mailing Address - Country:US
Mailing Address - Phone:617-694-4679
Mailing Address - Fax:
Practice Address - Street 1:130 WOODROW AVE APT 1
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3264
Practice Address - Country:US
Practice Address - Phone:617-694-4679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17133V00000X
IL837799133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered