Healthcare Provider Details

I. General information

NPI: 1356627772
Provider Name (Legal Business Name): ANDREA BYTHER MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 01/29/2024
Certification Date: 01/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 DAVENPORT STREET
MILFORD ME
04461-1021
US

IV. Provider business mailing address

PO BOX 394
MILFORD ME
04461-0394
US

V. Phone/Fax

Practice location:
  • Phone: 207-423-6895
  • Fax:
Mailing address:
  • Phone: 207-423-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI795
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: