Provider Demographics
NPI:1902315708
Name:ALLFATHER, ANASTASIA ELYSE (PA, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:ELYSE
Last Name:ALLFATHER
Suffix:
Gender:F
Credentials:PA, RD, LDN
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:ARENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4229133V00000X
363A00000X
MAPA8887363A00000X
MAPENDING2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery