Healthcare Provider Details

I. General information

NPI: 1013389733
Provider Name (Legal Business Name): CORINNE S ZAVAGLIA MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS CORINNE S LARSON

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WEST ST
CROMWELL CT
06416-1931
US

IV. Provider business mailing address

20 TAUNTON ST
SOUTHINGTON CT
06489-3724
US

V. Phone/Fax

Practice location:
  • Phone: 860-854-6613
  • Fax:
Mailing address:
  • Phone: 203-915-6079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1376
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: