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General NPI Number Information
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NPI Number | 1932334133
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Entity Type | Organization
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Legal Business Name | MEDICAL NUTRITION THERAPY ASSOCIATES LLC
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 6 RAYMOND RD
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City | AVON
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State | CT
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Zip | 06001-3629
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Country | US
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Telephone | 860-677-4429
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Fax | 860-677-4429
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Provider Business Mailing Address
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Address Line | 6 RAYMOND RD
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City | AVON
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State | CT
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Zip | 06001-3629
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Country | US
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Telephone | 860-677-4429
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Fax | 860-677-4429
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | SHARON LESLEY WERNER
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Credential | RD
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Telephone | 860-677-4429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0003927994
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License Number State | CT
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