Provider Demographics
NPI:1437375920
Name:ARCHAMBAULT, ELIZABETH JOSLOW (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JOSLOW
Last Name:ARCHAMBAULT
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:JOSLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412
Mailing Address - Country:US
Mailing Address - Phone:860-526-3250
Mailing Address - Fax:860-526-2412
Practice Address - Street 1:400 SAYBROOK RD
Practice Address - Street 2:SHORELINE SURGICAL ASSOCIATES SUITE 110
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-347-9167
Practice Address - Fax:860-347-1630
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT851471133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered