Provider Demographics
NPI:1770377954
Name:MARSHALL, JUDITH (MS)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4929
Mailing Address - Country:US
Mailing Address - Phone:646-489-7899
Mailing Address - Fax:
Practice Address - Street 1:28 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4929
Practice Address - Country:US
Practice Address - Phone:646-489-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23119998133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education