Provider Demographics
NPI:1356681910
Name:O'CONNOR, STACI ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:ANN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 AUDI LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-3252
Mailing Address - Country:US
Mailing Address - Phone:203-296-1935
Mailing Address - Fax:
Practice Address - Street 1:55 AUDI LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-3252
Practice Address - Country:US
Practice Address - Phone:203-296-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001190133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered