Provider Demographics
NPI:1770970840
Name:GRATOPP, DELAYNE (NMD)
Entity type:Individual
Prefix:DR
First Name:DELAYNE
Middle Name:
Last Name:GRATOPP
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6738
Mailing Address - Country:US
Mailing Address - Phone:917-720-3316
Mailing Address - Fax:
Practice Address - Street 1:917 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-6738
Practice Address - Country:US
Practice Address - Phone:917-720-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133N00000X133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist