Provider Demographics
NPI:1124140215
Name:PAT VASCONCELLOS
Entity type:Organization
Organization Name:PAT VASCONCELLOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, DIABETES EDUC
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:VASCONCELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:508-246-1724
Mailing Address - Street 1:7 WALKERWOODS DR
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2060
Mailing Address - Country:US
Mailing Address - Phone:508-246-1724
Mailing Address - Fax:
Practice Address - Street 1:133 FALMOUTH RD STE F
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-2611
Practice Address - Country:US
Practice Address - Phone:508-246-1724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1741133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0077Medicare ID - Type Unspecified