Provider Demographics
NPI:1265987218
Name:ARCHIBALD, ELIZABETH (MPH, RDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BAILEY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4546
Mailing Address - Country:US
Mailing Address - Phone:203-561-7639
Mailing Address - Fax:
Practice Address - Street 1:24 BAILEY AVE STE 2
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4546
Practice Address - Country:US
Practice Address - Phone:203-561-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000770133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered