Healthcare Provider Details

I. General information

NPI: 1295546828
Provider Name (Legal Business Name): LEYDY CAROLINA RAMIREZ CASTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 QUARRY ST APT A
BRIDGEPORT CT
06606-4334
US

IV. Provider business mailing address

40 QUARRY ST APT A
BRIDGEPORT CT
06606-4334
US

V. Phone/Fax

Practice location:
  • Phone: 203-895-6240
  • Fax:
Mailing address:
  • Phone: 203-895-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number86392786
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: