Individual
MRS. SUSAN MOFFATT AGNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
29 KRIPES RD, EAST GRANBY, CT 06026-9669
(860) 413-3883
(860) 413-3884
Mailing address
PO BOX 152, SIMSBURY, CT 06070-0152
(860) 413-3883
(860) 413-3884
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
709473
CT
Other
Enumeration date
05/02/2012
Last updated
05/02/2012
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