Provider Demographics
NPI:1932106614
Name:MALOY, MARY (RD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MALOY
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 1:400 MANSFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2023
Mailing Address - Country:US
Mailing Address - Phone:203-710-6322
Mailing Address - Fax:
Practice Address - Street 1:400 MANSFIELD ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2023
Practice Address - Country:US
Practice Address - Phone:203-710-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000718133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
442444OtherADA REGISTRATION NUMBER