Provider Demographics
NPI:1902513237
Name:SCUDERI, AVERY (RD)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:SCUDERI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MILL PLAIN RD UNIT 6-2
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5162
Mailing Address - Country:US
Mailing Address - Phone:914-462-2270
Mailing Address - Fax:
Practice Address - Street 1:55 MILL PLAIN RD UNIT 6-2
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5162
Practice Address - Country:US
Practice Address - Phone:914-462-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86117895133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty