Provider Demographics
NPI:1992280945
Name:MUSZYNSKI, JACQUELINE M (RDN, LDN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:MUSZYNSKI
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:M
Other - Last Name:MUSZYNSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CDN
Mailing Address - Street 1:1224 MILL ST BLDG B227C
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023-1159
Mailing Address - Country:US
Mailing Address - Phone:860-351-3144
Mailing Address - Fax:
Practice Address - Street 1:1224 MILL ST BLDG B227C
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1159
Practice Address - Country:US
Practice Address - Phone:860-351-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1641133V00000X
CT001641133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered