Provider Demographics
NPI:1194964908
Name:PLANO, AMY L (RD)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:PLANO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:KRYSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:YNHH NUTRITION CLINIC - CBB ROOM 52
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2422
Mailing Address - Fax:203-688-2141
Practice Address - Street 1:500 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3530
Practice Address - Country:US
Practice Address - Phone:203-671-3392
Practice Address - Fax:888-855-7803
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000887133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD300057442OtherAMY PLANO MEDICARE NUMBER
CTC02658OtherYNHH MEDICARE NUMBER