Provider Demographics
NPI:1235812884
Name:REEDER, KELSEY PRICE (DCN, RD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:PRICE
Last Name:REEDER
Suffix:
Gender:F
Credentials:DCN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 STRATFORD AVE APT 412
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6381
Mailing Address - Country:US
Mailing Address - Phone:954-494-2147
Mailing Address - Fax:
Practice Address - Street 1:623 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4548
Practice Address - Country:US
Practice Address - Phone:954-494-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT086292829133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered