Provider Demographics
NPI:1558943407
Name:AYALA, JENNIFER (CNS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WINSLOW LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3756
Mailing Address - Country:US
Mailing Address - Phone:203-550-2048
Mailing Address - Fax:
Practice Address - Street 1:14 WINSLOW LN
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3756
Practice Address - Country:US
Practice Address - Phone:203-550-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist