Stacy Kennedy, MPH,RD,LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1287 Issued in MA

Practice address

1404 Commonwealth Ave
#4
Brighton, MA 02135-3722

Phone

(617) 713-2835

Fax

(617) 632-4095

NPI assigned

Aug 8, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1235149931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 COMMONWEALTH AVE",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 COMMONWEALTH AVE",
            "address_2": "#4",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353722",
            "telephone_number": "617-713-2835",
            "fax_number": "617-632-4095"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Campus Dr Unit 108",
            "address_purpose": "LOCATION",
            "city": "Scarborough",
            "state": "ME",
            "postal_code": "040747172",
            "country_code": "US",
            "telephone_number": "207-303-3300",
            "fax_number": "207-250-2139",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "51 US Route 1 Ste I",
            "address_purpose": "LOCATION",
            "city": "Scarborough",
            "state": "ME",
            "postal_code": "040747145",
            "country_code": "US",
            "telephone_number": "207-303-3300",
            "fax_number": "207-250-2139",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 Topsham Fair Mall Rd Unit 1",
            "address_purpose": "LOCATION",
            "city": "Topsham",
            "state": "ME",
            "postal_code": "040861773",
            "country_code": "US",
            "telephone_number": "207-303-3300",
            "fax_number": "207-250-2137",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "155 Borthwick Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "NH",
            "postal_code": "038017156",
            "country_code": "US",
            "telephone_number": "603-828-0100",
            "fax_number": "603-828-0111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Independence Dr",
            "address_purpose": "LOCATION",
            "city": "Kennebunk",
            "state": "ME",
            "postal_code": "040436078",
            "country_code": "US",
            "telephone_number": "207-303-3300",
            "fax_number": "207-250-2144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "STACY",
        "credential": "MPH,RD,LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ME",
            "license": "DI1769",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NH",
            "license": "1338",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "1287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Rose Kelley
• Jonathan Kelly, DPM
• Gail N Kemp
• Charles Thomas Kendrick, M.D., D.M.D.
• Jessica Kendrick, PH.D., RN
• Lawrence A. Kenney, MD
• Alexander Kenny
• Maureen Kenny, PHD
• Lisa Marie Keyes, M.AC.
• Gurujot Singh Khalsa, D.C.

• Registered Dietitian in Brighton, MA
• Providers in Brighton, MA by specialty
• Registered Dietitian in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.