Healthcare Provider Details

I. General information

NPI: 1760303457
Provider Name (Legal Business Name): CAROLYN GRACE CIANFARANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8355 HIGHLAND RD
WHITE LAKE MI
48386-2017
US

IV. Provider business mailing address

1777 BRISTOL DR
MILFORD MI
48380-2032
US

V. Phone/Fax

Practice location:
  • Phone: 248-666-6005
  • Fax:
Mailing address:
  • Phone: 586-256-3926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86010841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: