Provider Demographics
NPI:1770028383
Name:MUCCI, NICOLE (RD, CD-N, CEDS)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:MUCCI
Suffix:
Gender:F
Credentials:RD, CD-N, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2761
Mailing Address - Country:US
Mailing Address - Phone:203-507-6613
Mailing Address - Fax:
Practice Address - Street 1:239 GLENVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-4172
Practice Address - Country:US
Practice Address - Phone:203-815-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001136133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered