Provider Demographics
NPI:1912573106
Name:TARTAGLIA, SIMONE (RD-CD-N)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:TARTAGLIA
Suffix:
Gender:F
Credentials:RD-CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BOTSFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-450-4745
Mailing Address - Fax:203-693-4304
Practice Address - Street 1:55 BOTSFORD AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-450-4745
Practice Address - Fax:203-693-4304
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86032106133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered