Provider Demographics
NPI:1285226282
Name:DELUCA, CHARLENE MICHELE (MS, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:MICHELE
Last Name:DELUCA
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NUVANCE HEALTH MEDICAL PRACTICE
Mailing Address - Street 2:111 OSBORNE STREET-ENTRANCE 4
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-739-7119
Mailing Address - Fax:203-739-1669
Practice Address - Street 1:111 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6000
Practice Address - Country:US
Practice Address - Phone:203-739-7119
Practice Address - Fax:203-739-1669
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000291133V00000X
CT2326133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered