Provider Demographics
NPI:1861995599
Name:CASTELL WATTS, AUDREY (RD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:CASTELL WATTS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:CASTELL-WATTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:58 PARK TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5233
Mailing Address - Country:US
Mailing Address - Phone:203-598-2606
Mailing Address - Fax:
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:203-598-2606
Practice Address - Fax:888-855-7803
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86037307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered