Healthcare Provider Details

I. General information

NPI: 1801083498
Provider Name (Legal Business Name): KITTIE LEE SPEDDING MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SAYBROOK RD STE 210
MIDDLETOWN CT
06457-4700
US

IV. Provider business mailing address

28 CRESCENT ST
MIDDLETOWN CT
06457-3654
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-2970
  • Fax: 860-347-1630
Mailing address:
  • Phone: 860-358-2970
  • Fax: 860-704-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: