Healthcare Provider Details

I. General information

NPI: 1942570569
Provider Name (Legal Business Name): ERICA GEORGIANNE KASULI MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 DANBURY RD SUITE 4
RIDGEFIELD CT
06877-3227
US

IV. Provider business mailing address

65 SPRING VALLEY RD
RIDGEFIELD CT
06877-1218
US

V. Phone/Fax

Practice location:
  • Phone: 917-284-0277
  • Fax:
Mailing address:
  • Phone: 917-284-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number001076
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number001076
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number001076
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number001076
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number001076
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number001076
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: