MEDICARE: MRS. DEBRA ANNE STOPPER I R.D., CD-N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	000043	CT

General Provider Information

NPI Number	:	1013057835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA ANNE STOPPER I R.D., CD-N

Provider Business Mailing Address
First Line	:	35 SIDE HILL RD
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3025
Country	:	US
Telephone Number	:	203-287-8781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 EVERGREEN AVE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-2717
Country	:	US
Telephone Number	:	203-248-8047
Fax Number	:	203-248-8047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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