Individual
CAROL ELIZABETH SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, CSO, LDN
Contact information
Practice address
152 SIMONDS RD, LEXINGTON, MA 02420-1621
(617) 894-4930
Mailing address
152 SIMONDS RD, LEXINGTON, MA 02420-1621
(617) 894-4930
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2433
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861513327
—
MA
Enumeration date
04/03/2007
Last updated
02/23/2022
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