Provider Demographics
NPI:1417127838
Name:GRACE-FARFAGLIA, PATRICIA M (RD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:M
Last Name:GRACE-FARFAGLIA
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 1:42 HORSESHOE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1039
Mailing Address - Country:US
Mailing Address - Phone:203-270-0097
Mailing Address - Fax:203-364-0067
Practice Address - Street 1:42 HORSESHOE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1039
Practice Address - Country:US
Practice Address - Phone:203-270-0097
Practice Address - Fax:203-364-0067
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000088133V00000X
NY006582133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered