Provider Demographics
NPI:1902260771
Name:RIVERA, SHEILA A
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:A
Other - Last Name:MEGAZZINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:261 PAPER MILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1735
Mailing Address - Country:US
Mailing Address - Phone:413-244-7839
Mailing Address - Fax:
Practice Address - Street 1:261 PAPER MILL RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1735
Practice Address - Country:US
Practice Address - Phone:413-244-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered