MEDICARE: MS. JEANNE SUSAN PICI M.S., 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	000005	CT
2	133V00000X	Registered Dietitian	000706-01	NY

General Provider Information

NPI Number	:	1831330752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE SUSAN PICI M.S., R.D., CD-N

Provider Business Mailing Address
First Line	:	6 MIDBROOK LN
Second Line	:
City	:	OLD GREENWICH
State	:	CT
Zip	:	06870-1428
Country	:	US
Telephone Number	:	203-637-9163
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 MIDBROOK LN
Second Line	:
City	:	OLD GREENWICH
State	:	CT
Zip	:	06870-1428
Country	:	US
Telephone Number	:	203-637-9163
Fax Number	:

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

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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