Provider Demographics
NPI:1063510477
Name:DURELL, STEPHEN (RD, LDN)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:DURELL
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 HARRINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:EAST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01515
Mailing Address - Country:US
Mailing Address - Phone:413-283-3411
Mailing Address - Fax:
Practice Address - Street 1:246 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01515-1713
Practice Address - Country:US
Practice Address - Phone:413-283-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1401133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered