Healthcare Provider Details

I. General information

NPI: 1134972870
Provider Name (Legal Business Name): KAILYN WOYAK RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

101 CANNER ST
NEW HAVEN CT
06511-2201
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-5008
  • Fax:
Mailing address:
  • Phone: 484-226-9981
  • Fax:

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: