Provider Demographics
NPI:1447558085
Name:VIGNATI, SUSANNE (RD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:VIGNATI
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 1:112 FOX DEN RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2543
Mailing Address - Country:US
Mailing Address - Phone:860-404-0384
Mailing Address - Fax:
Practice Address - Street 1:5 EASTVIEW DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1231
Practice Address - Country:US
Practice Address - Phone:860-404-0384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000789133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered