Provider Demographics
NPI:1225795115
Name:EVDOKIMOVA, JULIA (RDN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:EVDOKIMOVA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOWARD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-8074
Mailing Address - Country:US
Mailing Address - Phone:207-409-0376
Mailing Address - Fax:
Practice Address - Street 1:1 HOWARD AVE APT 1
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-8074
Practice Address - Country:US
Practice Address - Phone:207-409-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5471-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered