Provider Demographics
NPI:1174950695
Name:DACEY, ANDREA FRANCOISE (RDN, CSSD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:FRANCOISE
Last Name:DACEY
Suffix:
Gender:F
Credentials:RDN, CSSD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:FRANCOISE
Other - Last Name:VISAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CSSD
Mailing Address - Street 1:6 TIMBER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1647
Mailing Address - Country:US
Mailing Address - Phone:619-922-0944
Mailing Address - Fax:
Practice Address - Street 1:6 TIMBER RIDGE LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1647
Practice Address - Country:US
Practice Address - Phone:619-922-0944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-29
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1032407133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic