MEDICARE: COLLEEN DUDDY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1336930460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLEEN DUDDY LLC

Provider Business Mailing Address
First Line	:	123 WEBSTER ST APT 1
Second Line	:
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-2968
Country	:	US
Telephone Number	:	978-760-4144
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 WEBSTER ST APT 1
Second Line	:
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-2968
Country	:	US
Telephone Number	:	978-760-4144
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COLLEEN DUDDY
Credential	:	RDN
Telephone Number	:	978-760-4144

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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