Provider Demographics
NPI:1760622591
Name:DIPAOLA, JUDY (RDN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:DIPAOLA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SALEM ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-0147
Mailing Address - Country:US
Mailing Address - Phone:781-504-6108
Mailing Address - Fax:
Practice Address - Street 1:591 NORTH AVE STE 4-2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1640
Practice Address - Country:US
Practice Address - Phone:781-504-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2402133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001025802Medicare PIN