Healthcare Provider Details

I. General information

NPI: 1235396870
Provider Name (Legal Business Name): JEAN A TRAINOR RD, CD-N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

PO BOX 18263
BRIDGEPORT CT
06601-3263
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-5946
  • Fax: 203-867-5287
Mailing address:
  • Phone: 508-595-0531
  • Fax: 508-829-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000112
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: