Healthcare Provider Details

I. General information

NPI: 1619663614
Provider Name (Legal Business Name): COLLEEN MARIE CAULFIELD MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN MARIE HERMAN

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST FL 4
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

222 PHILADELPHIA PIKE STE 13-15
WILMINGTON DE
19809-3166
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-3475
  • Fax: 302-325-5889
Mailing address:
  • Phone: 302-407-5316
  • Fax: 302-407-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN008017
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0011081
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: