Provider Demographics
NPI:1598137853
Name:DYNES, ANDREA (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:DYNES
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2743
Mailing Address - Country:US
Mailing Address - Phone:978-771-9592
Mailing Address - Fax:
Practice Address - Street 1:114 JOHN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2743
Practice Address - Country:US
Practice Address - Phone:978-771-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1420133V00000X
MA3716133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered