Provider Demographics
NPI:1780897884
Name:SHORELINE NUTRITION COUNSELING, LLC
Entity type:Organization
Organization Name:SHORELINE NUTRITION COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER OF LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GAFFNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:203-483-4383
Mailing Address - Street 1:175 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3019
Mailing Address - Country:US
Mailing Address - Phone:203-483-4383
Mailing Address - Fax:203-483-4386
Practice Address - Street 1:175 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3019
Practice Address - Country:US
Practice Address - Phone:203-483-4383
Practice Address - Fax:203-483-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000527133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty