Healthcare Provider Details

I. General information

NPI: 1437375920
Provider Name (Legal Business Name): ELIZABETH JOSLOW ARCHAMBAULT REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN JOSLOW

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SAYBROOK RD SHORELINE SURGICAL ASSOCIATES SUITE 110
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

2 OLD COUNTY RD
CHESTER CT
06412
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-9167
  • Fax: 860-347-1630
Mailing address:
  • Phone: 860-526-3250
  • Fax: 860-526-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number851471
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: