Provider Demographics
NPI:1588016927
Name:MENDES, CAROLINE (RD)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:MENDES
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 1:1 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-2229
Mailing Address - Country:US
Mailing Address - Phone:617-797-7206
Mailing Address - Fax:
Practice Address - Street 1:69 HICKORY DR
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1011
Practice Address - Country:US
Practice Address - Phone:781-647-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3722133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered