Provider Demographics
NPI:1831773506
Name:KRISTEN SMALDONE NUTRITION LLC
Entity type:Organization
Organization Name:KRISTEN SMALDONE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CSP, CD-N
Authorized Official - Phone:203-444-7822
Mailing Address - Street 1:113 MILL PLAIN RD # 1007
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5277
Mailing Address - Country:US
Mailing Address - Phone:203-444-7822
Mailing Address - Fax:
Practice Address - Street 1:4 WILLIAMS LN
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1816
Practice Address - Country:US
Practice Address - Phone:203-444-7822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty