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General NPI Number Information
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NPI Number | 1235315359
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Entity Type | Individual
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Provider Name | MARIA MAE MAHADY RD, LD
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Gender | Female
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 2800 CLEVELAND AVE N
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City | ROSEVILLE
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State | MN
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Zip | 55113-1126
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Country | US
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Telephone | 651-604-5198
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Fax |
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Provider Business Mailing Address
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Address Line | 871 PONTIAC LN
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City | CHANHASSEN
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State | MN
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Zip | 55317-9429
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number |
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License Number State |
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