Healthcare Provider Details

I. General information

NPI: 1912744251
Provider Name (Legal Business Name): AISLINN BRAGAIA RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AISLINN ELLERBROOK RD, LDN

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 INDUSTRIAL AVE STE 130
WILLISTON VT
05495-4449
US

IV. Provider business mailing address

971 HOPMEADOW ST APT 29
SIMSBURY CT
06070-2041
US

V. Phone/Fax

Practice location:
  • Phone: 802-222-6907
  • Fax:
Mailing address:
  • Phone: 201-673-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number074.0134650
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND10289
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: