Provider Demographics
NPI:1093907206
Name:SPAIDE, JENNIFER LEE (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:SPAIDE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 EAST AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5710
Mailing Address - Country:US
Mailing Address - Phone:203-642-3737
Mailing Address - Fax:
Practice Address - Street 1:161 EAST AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5710
Practice Address - Country:US
Practice Address - Phone:203-642-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education