Healthcare Provider Details

I. General information

NPI: 1437262102
Provider Name (Legal Business Name): EDYTH LAYNG MCCLURE R.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/25/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 FOX RUN DR
SOUTHBURY CT
06488-4408
US

IV. Provider business mailing address

94 FOX RUN DRIVE
SOUTHBURY CT
06488
US

V. Phone/Fax

Practice location:
  • Phone: 203-267-4090
  • Fax: 203-267-4057
Mailing address:
  • Phone: 203-267-4090
  • Fax: 203-267-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: