Provider Demographics
NPI:1912573247
Name:DYLEWSKI, JACLYN (RD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:DYLEWSKI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:37 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2503
Mailing Address - Country:US
Mailing Address - Phone:203-560-8407
Mailing Address - Fax:
Practice Address - Street 1:330 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4383
Practice Address - Country:US
Practice Address - Phone:860-246-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5237133V00000X
CT2532133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered