Provider Demographics
NPI:1912790908
Name:MCMILLAN, MOLLY FAY (RD)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:FAY
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:FAY
Other - Last Name:WINSTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:38 PHILLIPS BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2431
Mailing Address - Country:US
Mailing Address - Phone:321-750-3977
Mailing Address - Fax:
Practice Address - Street 1:38 PHILLIPS BEACH AVE
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2431
Practice Address - Country:US
Practice Address - Phone:321-750-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86104262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered