Individual
EILEEN MARY TICHY
Active
Individual
EILEEN MARY TICHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC RD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
PENDING
CT
363AM0700X
Medical Physician Assistant
Primary
001042
CT
Other
Enumeration date
10/31/2006
Last updated
04/01/2011
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