Provider Demographics
NPI:1568120947
Name:DEANE, ASHLEY L (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:DEANE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:L
Other - Last Name:WALTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:128 TANNERY RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4841
Mailing Address - Country:US
Mailing Address - Phone:413-330-8167
Mailing Address - Fax:
Practice Address - Street 1:77 MILL ST STE 233
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4598
Practice Address - Country:US
Practice Address - Phone:413-330-8167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4296133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered