Judith Donnelly, R.D.,L.D.
Individual provider Active NPI Registered Dietitian · Portland, ME
NPI 1356353452 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1356353452
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- D1433 (ME)
- Practice address
- 805 Stevens Ave
Portland, ME 04103-2626 - Phone
- (207) 772-6279
- Fax
- (207) 772-6279
- NPI assigned
- Aug 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D1433 | ME | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D1433 | ME | Yes |
Addresses
Primary practice location
805 Stevens Ave
Portland, ME 04103-2626
Mailing address
805 Stevens Ave
Portland, ME 04103-2626
Phone (207) 772-6279
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11339866 | Other | ME | CAQH PROVIDER ID |
Other providers in Portland, ME
- Kari L Donatelli
- Debra J Donelson
- Martin P. Donlon
- Patrick Donnellan
- Thomas Xavier Donnellan
- Maeve Grace Donnelly
- Christine Johanna Donohue
- Heather H Donohue
- Timothy John Donohue
- John- Paul Donovan
All providers in Portland, ME · Registered Dietitian in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.