Provider Demographics
NPI:1841934437
Name:MILLER, LINDSEY (LDN, MS)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LDN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BIRCHBANK RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1700
Mailing Address - Country:US
Mailing Address - Phone:752-101-1184
Mailing Address - Fax:
Practice Address - Street 1:65 BIRCHBANK RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1700
Practice Address - Country:US
Practice Address - Phone:475-210-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002165133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002165OtherDEPARTMENT OF PUBLIC HEALTH