Provider Demographics
NPI:1154850493
Name:RADZIEJOWSKA, JOANNA (RDN, RD)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:RADZIEJOWSKA
Suffix:
Gender:F
Credentials:RDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 NOBSCOT RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3341
Mailing Address - Country:US
Mailing Address - Phone:617-840-1269
Mailing Address - Fax:
Practice Address - Street 1:97 LOWELL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1733
Practice Address - Country:US
Practice Address - Phone:978-233-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2453133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered