Healthcare Provider Details

I. General information

NPI: 1689172660
Provider Name (Legal Business Name): VALERIE GOLDBERG RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 BAYBERRY CIRCLE APT 204
BURLINGTON VT
05401
US

IV. Provider business mailing address

163 BAYBERRY CIR UNIT 204
BURLINGTON VT
05401-5510
US

V. Phone/Fax

Practice location:
  • Phone: 646-771-7517
  • Fax:
Mailing address:
  • Phone: 646-771-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86095453
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: