Provider Demographics
NPI:1932435096
Name:DAVIDSON, HEIDI (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MS, 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 SELKIRK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-5629
Mailing Address - Country:US
Mailing Address - Phone:617-877-2202
Mailing Address - Fax:
Practice Address - Street 1:33 BEDFORD ST
Practice Address - Street 2:SUITE 20
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4319
Practice Address - Country:US
Practice Address - Phone:617-877-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered