Provider Demographics
NPI:1750821583
Name:TAMAYO, AUDRA JUNE (MS, RDN)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:JUNE
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 EVERGREEN PL
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1022
Mailing Address - Country:US
Mailing Address - Phone:978-390-5364
Mailing Address - Fax:
Practice Address - Street 1:17 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1022
Practice Address - Country:US
Practice Address - Phone:978-390-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered