Provider Demographics
NPI:1407384589
Name:MEYER, PAULA (RD MS)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:RD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2629
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-0629
Mailing Address - Country:US
Mailing Address - Phone:203-216-2641
Mailing Address - Fax:
Practice Address - Street 1:10 BAY ST STE 2C
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4324
Practice Address - Country:US
Practice Address - Phone:203-216-2641
Practice Address - Fax:203-557-0572
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000836133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered