Provider Demographics
NPI:1598630600
Name:AZZARONE, TARA (RD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:AZZARONE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAPLE WAY
Mailing Address - Street 2:BOYLSTON, MA 01505
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-1545
Mailing Address - Country:US
Mailing Address - Phone:508-769-5703
Mailing Address - Fax:508-769-5703
Practice Address - Street 1:20 MAPLE WAY
Practice Address - Street 2:BOYLSTON, MA 01505
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1545
Practice Address - Country:US
Practice Address - Phone:508-769-5703
Practice Address - Fax:508-769-5703
Is Sole Proprietor?:No
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2141133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered