Healthcare Provider Details

I. General information

NPI: 1104794296
Provider Name (Legal Business Name): DILLON MICHAEL BENEDICTO RD/RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 LINCOLN RD # 1218
WALPOLE MA
02081-1218
US

IV. Provider business mailing address

4 EUROPE ST APT 2
PROVIDENCE RI
02903-5436
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-7703
  • Fax:
Mailing address:
  • Phone: 631-697-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: