Individual
LORI SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S, R.D.
Contact information
Practice address
7 HILLSIDE DR, SOUTH WINDSOR, CT 06074-1396
(800) 658-0512
(866) 387-4207
Mailing address
7 HILLSIDE DR, SOUTH WINDSOR, CT 06074-1396
(800) 658-0512
(866) 387-4207
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12247539
CAQH
CT
Enumeration date
09/06/2012
Last updated
03/31/2014
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