Provider Demographics
NPI:1982862454
Name:BRADVICA, CHRISTINE (RD,LDN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BRADVICA
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:BRADVICA
Other - Last Name:SENTOVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD,LDN
Mailing Address - Street 1:200 SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1114
Mailing Address - Country:US
Mailing Address - Phone:781-687-2463
Mailing Address - Fax:781-687-2698
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-2463
Practice Address - Fax:781-687-2698
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1750133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered