Provider Demographics
NPI:1508646415
Name:MCNAMARA, KAILEY (MED, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:MED, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 MANNING ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1044
Mailing Address - Country:US
Mailing Address - Phone:508-353-2325
Mailing Address - Fax:
Practice Address - Street 1:8 FLORAL AVE
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4829
Practice Address - Country:US
Practice Address - Phone:617-257-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN7053133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered