Healthcare Provider Details

I. General information

NPI: 1336071851
Provider Name (Legal Business Name): MICHELLE PATRICE MACKENZIE MS, RDN, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 PARKER FARMS RD
WALLINGFORD CT
06492-2858
US

IV. Provider business mailing address

219 PARKER FARMS RD
WALLINGFORD CT
06492-2858
US

V. Phone/Fax

Practice location:
  • Phone: 203-631-1146
  • Fax:
Mailing address:
  • Phone: 203-631-1146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000407
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number000407
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: