Provider Demographics
NPI:1346716156
Name:TEAL, JULIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TEAL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:DIGERONIMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-0618
Mailing Address - Country:US
Mailing Address - Phone:978-631-0322
Mailing Address - Fax:
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3575
Practice Address - Country:US
Practice Address - Phone:978-631-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00003873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered