Provider Demographics
NPI:1750149597
Name:WALTON, BRANDON JAMES
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:WALTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01050-9613
Mailing Address - Country:US
Mailing Address - Phone:978-257-3874
Mailing Address - Fax:
Practice Address - Street 1:320 RIVERSIDE DR STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-2700
Practice Address - Country:US
Practice Address - Phone:413-586-2000
Practice Address - Fax:413-584-7076
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86371847133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered