Individual
MARY DISANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 HIGH SERVICE AVE, NORTH PROVIDENCE, RI 02904-5113
(401) 456-3193
(401) 456-6742
Mailing address
3 LONGUE VUE AVE, N PROVIDENCE, RI 02904-4226
(401) 241-4119
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDN00035
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LDN00035
LICENSE
RI
Enumeration date
02/12/2014
Last updated
02/12/2014
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