Provider Demographics
NPI:1235136797
Name:HALADYNA, CAROL A (RD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:HALADYNA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9120
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02027-9120
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-278-5664
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA139133V00000X
RI497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LD0020OtherBSBLUE CARE ELECT
634102OtherTUFTS SECURE HORIZON
LD0020OtherBS-BLUE CARE 65
634102OtherTUFTS BENEFITS ADMINISTRA
634102OtherTUFTS TOTAL HEALTH PLAN
LD0020OtherBS-INDEMNITY
634102OtherTUFTS
634102OtherTUFTS COMMONWEALTH PPO
LD0020OtherHMO BLUE/BLUE CHOICE
LD0020OtherBS-BLUE CARE 65
LD0020OtherBS-INDEMNITY