Provider Demographics
NPI:1013389733
Name:ZAVAGLIA, CORINNE S (MS, RDN)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:S
Last Name:ZAVAGLIA
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:MISS
Other - First Name:CORINNE
Other - Middle Name:S
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 TAUNTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3724
Mailing Address - Country:US
Mailing Address - Phone:203-915-6079
Mailing Address - Fax:
Practice Address - Street 1:101 WEST ST
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1931
Practice Address - Country:US
Practice Address - Phone:860-854-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered