Provider Demographics
NPI:1487053559
Name:PENNEY, ALEXIS (MS, RD, LDN)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:
Last Name:PENNEY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 EDGAR CT UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1409
Mailing Address - Country:US
Mailing Address - Phone:774-722-2152
Mailing Address - Fax:833-232-0836
Practice Address - Street 1:8 EDGAR CT UNIT 2
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1409
Practice Address - Country:US
Practice Address - Phone:774-722-2152
Practice Address - Fax:833-232-0836
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered