Provider Demographics
NPI:1891394870
Name:MORA, ENJELY (MS RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:ENJELY
Middle Name:
Last Name:MORA
Suffix:
Gender:
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 1:156 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-1295
Mailing Address - Country:US
Mailing Address - Phone:781-588-6522
Mailing Address - Fax:
Practice Address - Street 1:867 BOYLSTON ST STE 1677
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2774
Practice Address - Country:US
Practice Address - Phone:781-588-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5195-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered