Provider Demographics
NPI:1235710997
Name:MAZZONI, D J (RD)
Entity Type:Individual
Prefix:MR
First Name:D
Middle Name:J
Last Name:MAZZONI
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10622 MAIN ST REAR UNIT2
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1641
Mailing Address - Country:US
Mailing Address - Phone:315-751-6286
Mailing Address - Fax:
Practice Address - Street 1:4 NATHAN PRATT DR UNIT 107
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4640
Practice Address - Country:US
Practice Address - Phone:781-591-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1394133V00000X
NY86079525133V00000X
MALDN6799133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered