Individual
MRS. AUDREY M YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN, CDE
Contact information
Practice address
2 FIRST AVENUE CENTENNIAL CROSSING, SUITE 112, PEABODY, MA 01960
(617) 240-6383
(978) 745-7982
Mailing address
MYSTIC HEALTHCARE, 137 MAIN STREET, MEDFORD, MA 01255
(781) 395-4761
(781) 395-5081
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
901
MA
133VN1004X
Pediatric Nutrition Registered Dietitian
901
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00376201
MEDICARE PTAN
MA
Enumeration date
05/01/2007
Last updated
12/22/2022
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