Provider Demographics
NPI:1750979886
Name:WOLOSZYN, SARA CHRISTINE (CD-N)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:CHRISTINE
Last Name:WOLOSZYN
Suffix:
Gender:F
Credentials:CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LINCOLN CITY RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06068-1710
Mailing Address - Country:US
Mailing Address - Phone:860-318-6311
Mailing Address - Fax:
Practice Address - Street 1:26 LINCOLN CITY RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:CT
Practice Address - Zip Code:06068-1710
Practice Address - Country:US
Practice Address - Phone:860-318-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001955133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist