Most Relevant Information
Provider Data
| NPI Number: | 1003563321 |
| Provider Name: | MALAYA MOUNT RD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/07/2022 |
| Last Updated: | 03/07/2022 |
Provider Practice Location
125 W MAIN ST
PLAINVILLE
CT
060621988
Practice Location Phone/Fax
| Phone: | 3608889293 |
| Fax: |
Provider Mailing Location
192 STODDARD AVE
NEWINGTON
CT
061111914
Provider Mailing Phone/Fax
| Phone: | 3608889293 |
| Fax: |