Provider Demographics
NPI:1487080198
Name:SMALLEY, ASHLEY (MS, RD, LD)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 US ROUTE 1 STE 22
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-7022
Mailing Address - Country:US
Mailing Address - Phone:207-200-5044
Mailing Address - Fax:207-544-5136
Practice Address - Street 1:491 US-1 SUITE 22
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032
Practice Address - Country:US
Practice Address - Phone:207-200-5044
Practice Address - Fax:207-544-5136
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1322133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered