Healthcare Provider Details

I. General information

NPI: 1265853113
Provider Name (Legal Business Name): MAUREEN WASIK RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 09/11/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 WASHINGTON AVE STE 8
HAMDEN CT
06518-3026
US

IV. Provider business mailing address

295 WASHINGTON AVE STE 8
HAMDEN CT
06518-3026
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-5473
  • Fax: 203-691-7563
Mailing address:
  • Phone: 203-248-5473
  • Fax: 203-691-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: