Provider Demographics
NPI:1285467506
Name:MONIQUE, ABBY (RD, LDN)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:MONIQUE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BENNINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1901
Mailing Address - Country:US
Mailing Address - Phone:508-314-0664
Mailing Address - Fax:
Practice Address - Street 1:27 BENNINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1901
Practice Address - Country:US
Practice Address - Phone:508-314-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered