Provider Demographics
NPI:1740808013
Name:GOODMAN, MEGHAN ELIZABETH (MS, RD, CDCES, CD-N)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MS, RD, CDCES, CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 INDIAN COVE RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3377
Mailing Address - Country:US
Mailing Address - Phone:203-640-0049
Mailing Address - Fax:
Practice Address - Street 1:125 INDIAN COVE RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-3377
Practice Address - Country:US
Practice Address - Phone:203-640-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001011133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered