Healthcare Provider Details

I. General information

NPI: 1730210808
Provider Name (Legal Business Name): SHARON DINA MS, CD-N, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 ALBION ST SOUTHWEST COMMUNITY HEALTH CENTER,INC
BRIDGEPORT CT
06605-2804
US

IV. Provider business mailing address

46 ALBION ST SOUTHWEST COMMUNITY HEALTH CENTER,INC
BRIDGEPORT CT
06605-2804
US

V. Phone/Fax

Practice location:
  • Phone: 203-330-6000
  • Fax: 203-330-6008
Mailing address:
  • Phone: 203-330-6000
  • Fax: 203-330-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number000466
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: