Provider Demographics
NPI:1750796512
Name:ROCHE, ANDREA (RD, LDN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ROCHE
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 1:3 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3716
Mailing Address - Country:US
Mailing Address - Phone:617-953-4243
Mailing Address - Fax:
Practice Address - Street 1:1266 FURNACE BROOK PKWY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4758
Practice Address - Country:US
Practice Address - Phone:617-953-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-152632174N00000X
MA3632133N00000X
MA86013220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered