Provider Demographics
NPI:1558156448
Name:HERSEY, JULIE L (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:L
Last Name:HERSEY
Suffix:
Gender:
Credentials:MS, RDN, LDN
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MENOUNOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LDN
Mailing Address - Street 1:468 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1762
Mailing Address - Country:US
Mailing Address - Phone:978-473-9681
Mailing Address - Fax:
Practice Address - Street 1:59 BEECH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-4837
Practice Address - Country:US
Practice Address - Phone:978-473-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3177133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered