Healthcare Provider Details

I. General information

NPI: 1053338905
Provider Name (Legal Business Name): DONALD MILTON STOKES MPH, RD, CDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 GLENBROOK RD SUITE 2C
STAMFORD CT
06906-1439
US

IV. Provider business mailing address

111 BEVERLY RD FLOOR 2
WETHERSFIELD CT
06109-3303
US

V. Phone/Fax

Practice location:
  • Phone: 800-658-0512
  • Fax: 866-387-4207
Mailing address:
  • Phone: 917-697-7614
  • Fax: 866-387-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number000764
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000764
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: