Provider Demographics
NPI:1326610684
Name:MANGAUDIS, NICOLE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MANGAUDIS
Suffix:
Gender:F
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 1:3 IMPERIAL PL
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1619
Mailing Address - Country:US
Mailing Address - Phone:508-688-7288
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM HEIGHTS
Practice Address - State:MA
Practice Address - Zip Code:02494-1262
Practice Address - Country:US
Practice Address - Phone:508-688-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered