Provider Demographics
NPI:1801468202
Name:JUDD, GABRIELLE ALEXANDRA (RD, CNSC, LDN)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ALEXANDRA
Last Name:JUDD
Suffix:
Gender:F
Credentials:RD, CNSC, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 S HIGH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4431
Mailing Address - Country:US
Mailing Address - Phone:803-370-1281
Mailing Address - Fax:
Practice Address - Street 1:236 S HIGH ST APT 5
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4431
Practice Address - Country:US
Practice Address - Phone:803-370-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3646133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered