Healthcare Provider Details

I. General information

NPI: 1629352208
Provider Name (Legal Business Name): SANDRA KRAEUTER KOPS PH.D., R.D., CD-N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BRINSMADE RD
HAMDEN CT
06514-1904
US

IV. Provider business mailing address

55 BRINSMADE RD
HAMDEN CT
06514-1904
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-2535
  • Fax:
Mailing address:
  • Phone: 203-288-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number001054
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: