Provider Demographics
NPI:1457936015
Name:ELDRIDGE, AMY JEAN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JEAN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:236 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-3818
Mailing Address - Country:US
Mailing Address - Phone:503-265-9396
Mailing Address - Fax:
Practice Address - Street 1:718 SMYTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-7007
Practice Address - Country:US
Practice Address - Phone:603-854-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5004133V00000X
NH1190133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty