Provider Demographics
NPI:1043011471
Name:SALVIN, ETANA
Entity type:Individual
Prefix:
First Name:ETANA
Middle Name:
Last Name:SALVIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BEECHCROFT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3091
Mailing Address - Country:US
Mailing Address - Phone:617-586-9961
Mailing Address - Fax:617-586-9961
Practice Address - Street 1:71 BEECHCROFT ST APT 2
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3091
Practice Address - Country:US
Practice Address - Phone:617-586-9961
Practice Address - Fax:617-586-9961
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86084404133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered