Provider Demographics
NPI:1437262102
Name:MCCLURE, EDYTH LAYNG (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:EDYTH
Middle Name:LAYNG
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 FOX RUN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-267-4090
Mailing Address - Fax:203-267-4057
Practice Address - Street 1:94 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4408
Practice Address - Country:US
Practice Address - Phone:203-267-4090
Practice Address - Fax:203-267-4057
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT710000153Medicare ID - Type Unspecified
CT710000153Medicare PIN