MEDICARE: COLLEEN DUDDY RDN

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	133V00000X	Registered Dietitian	LDN7340	MA

General Provider Information

NPI Number	:	1457174252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN DUDDY RDN

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2024
Last Update Date	:	11/01/2024

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