Provider Demographics
NPI:1215777206
Name:PAREDES, BORIS
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:PAREDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GOVERNORS DR APT 5
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-3217
Mailing Address - Country:US
Mailing Address - Phone:857-498-9840
Mailing Address - Fax:
Practice Address - Street 1:400 GOVERNORS DR APT 5
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-3217
Practice Address - Country:US
Practice Address - Phone:857-498-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YP2500X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional