Provider Demographics
NPI:1336930460
Name:COLLEEN DUDDY LLC
Entity type:Organization
Organization Name:COLLEEN DUDDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:978-760-4144
Mailing Address - Street 1:123 WEBSTER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2968
Mailing Address - Country:US
Mailing Address - Phone:978-760-4144
Mailing Address - Fax:
Practice Address - Street 1:123 WEBSTER ST APT 1
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2968
Practice Address - Country:US
Practice Address - Phone:978-760-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service