Healthcare Provider Details

I. General information

NPI: 1043290356
Provider Name (Legal Business Name): MARY SAVOYE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHURCH ST S SUITE 404
NEW HAVEN CT
06519-1717
US

IV. Provider business mailing address

2 CHURCH ST S SUITE 404
NEW HAVEN CT
06519-1717
US

V. Phone/Fax

Practice location:
  • Phone: 203-764-6767
  • Fax: 203-764-6748
Mailing address:
  • Phone: 203-764-6767
  • Fax: 203-764-6748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number000136
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: