Provider Demographics
NPI:1396271557
Name:FARAJ-ARDURA, JOYCELYN MINETTE (PHD, MS, RDN)
Entity type:Individual
Prefix:
First Name:JOYCELYN
Middle Name:MINETTE
Last Name:FARAJ-ARDURA
Suffix:
Gender:F
Credentials:PHD, MS, RDN
Other - Prefix:
Other - First Name:JOYCELYN
Other - Middle Name:MINETTE
Other - Last Name:FARAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833
Mailing Address - Country:US
Mailing Address - Phone:413-230-9706
Mailing Address - Fax:
Practice Address - Street 1:13 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833
Practice Address - Country:US
Practice Address - Phone:413-230-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001513133V00000X
NH1315133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered