Provider Demographics
NPI:1952999823
Name:FRY, JOCELYN MICHELLE (RD, CSP)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:MICHELLE
Last Name:FRY
Suffix:
Gender:F
Credentials:RD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3720
Mailing Address - Country:US
Mailing Address - Phone:530-575-8037
Mailing Address - Fax:650-736-2130
Practice Address - Street 1:750 WELCH RD STE 214
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1509
Practice Address - Country:US
Practice Address - Phone:650-497-3941
Practice Address - Fax:650-736-2130
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric