Provider Demographics
NPI:1851975817
Name:GUNDELL, CAROLYN R (CDCES)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:R
Last Name:GUNDELL
Suffix:
Gender:F
Credentials:CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SUGARLOAF DR
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2119
Mailing Address - Country:US
Mailing Address - Phone:203-984-1389
Mailing Address - Fax:
Practice Address - Street 1:80 SUGARLOAF DR
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2119
Practice Address - Country:US
Practice Address - Phone:203-984-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education