Provider Demographics
NPI:1215610456
Name:SEDOR, JALYN MAUREEN (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:JALYN
Middle Name:MAUREEN
Last Name:SEDOR
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CUMMINGS RD APT 5
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7348
Mailing Address - Country:US
Mailing Address - Phone:413-887-7702
Mailing Address - Fax:
Practice Address - Street 1:110 NEWBURY ST STE 6
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1097
Practice Address - Country:US
Practice Address - Phone:413-887-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6977133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered