Provider Demographics
NPI:1952914301
Name:O'GRADY, LOUISA (MS RD CDE CD-N)
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:MS RD CDE CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BEACON HILL TER
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5905
Mailing Address - Country:US
Mailing Address - Phone:203-258-5256
Mailing Address - Fax:
Practice Address - Street 1:7 BEACON HILL TER
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-5905
Practice Address - Country:US
Practice Address - Phone:203-258-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00955313133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered