Provider Demographics
NPI:1194949974
Name:STEIN, ANDREA (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:STEIN
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 1:14 HOBBS RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3710
Mailing Address - Country:US
Mailing Address - Phone:508-358-7192
Mailing Address - Fax:
Practice Address - Street 1:203 OAK ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1306
Practice Address - Country:US
Practice Address - Phone:508-653-4633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2577133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered