Provider Demographics
NPI:1871009530
Name:DUONG, SYDNEY ELIZABETH (RD)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:ELIZABETH
Last Name:DUONG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:SYDNEY
Other - Middle Name:ELIZABETH
Other - Last Name:LIBBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 SAINT MARY ST UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3163
Mailing Address - Country:US
Mailing Address - Phone:603-689-4908
Mailing Address - Fax:
Practice Address - Street 1:209 SAINT MARY ST UNIT 1A
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3163
Practice Address - Country:US
Practice Address - Phone:603-689-4908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5450-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered