Most Relevant Information
Provider Data
| NPI Number: | 1003224221 |
| Provider Name: | STACEY LEARY RD, CDN, CNSC |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 000933 |
Most Important Dates
| Enumeration Date: | 07/31/2014 |
| Last Updated: | 08/01/2014 |
Provider Practice Location
130 DIVISION ST
DERBY
CT
064181326
Practice Location Phone/Fax
| Phone: | 2037327585 |
| Fax: |
Provider Mailing Location
88 WASHINGTON AVE
SEYMOUR
CT
064833127
Provider Mailing Phone/Fax
| Phone: | 2032315544 |
| Fax: |