Provider Demographics
NPI:1952352379
Name:DELESSIO, DOROTHY LORRAINE (CDOE, CDE)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:LORRAINE
Last Name:DELESSIO
Suffix:
Gender:F
Credentials:CDOE, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BREWSTER ST
Mailing Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-2759
Mailing Address - Fax:401-729-2923
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2759
Practice Address - Fax:401-729-2923
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00127133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007056708OtherMEDICARE PTAN