MEDICARE: TONYA SPAULDING RDN, LD

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	DI1335	ME

General Provider Information

NPI Number	:	1891228250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA SPAULDING RDN, LD

Provider Business Mailing Address
First Line	:	19 SOUTH ST
Second Line	:	SUITE B, #7
City	:	PORTLAND
State	:	ME
Zip	:	04101-3963
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 SOUTH ST
Second Line	:	SUITE B, #7
City	:	PORTLAND
State	:	ME
Zip	:	04101-3963
Country	:	US
Telephone Number	:	207-332-8668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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