Provider Demographics
NPI:1447275466
Name:BYRON, ELLEN M (RDCDE, LDN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:BYRON
Suffix:
Gender:F
Credentials:RDCDE, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SUMMER ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6320
Mailing Address - Country:US
Mailing Address - Phone:978-373-6809
Mailing Address - Fax:978-373-6808
Practice Address - Street 1:215 SUMMER ST
Practice Address - Street 2:SUITE 8
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6320
Practice Address - Country:US
Practice Address - Phone:978-373-6809
Practice Address - Fax:978-373-6808
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA494133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered