Provider Demographics
NPI:1992300925
Name:DANIAR, MINDASARI PRIASTINI (RD)
Entity type:Individual
Prefix:
First Name:MINDASARI
Middle Name:PRIASTINI
Last Name:DANIAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MINDASARI
Other - Middle Name:
Other - Last Name:PRIASTINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 SPAULDING RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1021
Mailing Address - Country:US
Mailing Address - Phone:978-996-4734
Mailing Address - Fax:
Practice Address - Street 1:15 SPAULDING RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1021
Practice Address - Country:US
Practice Address - Phone:978-996-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5030133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered