Provider Demographics
NPI:1467070896
Name:MAHONEY, JULIANNE N (RD)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:N
Last Name:MAHONEY
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 1:9501 ASPENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1238
Mailing Address - Country:US
Mailing Address - Phone:240-643-1368
Mailing Address - Fax:
Practice Address - Street 1:9501 ASPENWOOD CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-1238
Practice Address - Country:US
Practice Address - Phone:240-643-1368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD86118763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered