Healthcare Provider Details

I. General information

NPI: 1871698415
Provider Name (Legal Business Name): CHRISTINE E GALLICHOTTE MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 FEDERAL RD UNIT C33B
BROOKFIELD CT
06804-2647
US

IV. Provider business mailing address

246 FEDERAL RD UNIT C33B
BROOKFIELD CT
06804-2647
US

V. Phone/Fax

Practice location:
  • Phone: 203-775-3536
  • Fax: 203-740-2725
Mailing address:
  • Phone: 203-775-3536
  • Fax: 203-740-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000121
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: