Provider Demographics
NPI:1407346398
Name:BOULAY, STEPHANIE AMBER (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:AMBER
Last Name:BOULAY
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 1:1646 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6819
Mailing Address - Country:US
Mailing Address - Phone:508-999-6400
Mailing Address - Fax:
Practice Address - Street 1:1646 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6819
Practice Address - Country:US
Practice Address - Phone:508-999-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered