Provider Demographics
NPI:1891228250
Name:SPAULDING, TONYA (RDN, LD)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SOUTH ST
Mailing Address - Street 2:SUITE B, #7
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 SOUTH ST
Practice Address - Street 2:SUITE B, #7
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3963
Practice Address - Country:US
Practice Address - Phone:207-332-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered