Healthcare Provider Details

I. General information

NPI: 1295952737
Provider Name (Legal Business Name): KRISTINE PADMANABHA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CONNOLLY PKWY BLDG. 17
HAMDEN CT
06514-2593
US

IV. Provider business mailing address

80 CARMEL ST
HAMDEN CT
06518-2923
US

V. Phone/Fax

Practice location:
  • Phone: 203-230-2815
  • Fax: 203-230-8502
Mailing address:
  • Phone: 203-288-2550
  • Fax: 203-230-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number000615
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000615
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: