Provider Demographics
NPI:1356899850
Name:MAGGIOLO, NICOLETTE STAR (RDN, LDN)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:STAR
Last Name:MAGGIOLO
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 WINTHROP SHORE DR APT 5
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1153
Mailing Address - Country:US
Mailing Address - Phone:201-458-4065
Mailing Address - Fax:
Practice Address - Street 1:249 WINTHROP SHORE DR APT 5
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1153
Practice Address - Country:US
Practice Address - Phone:201-458-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4192133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered