Provider Demographics
NPI:1871477810
Name:SMITH, ANGELA VICTORIA (MS, RD, CSN, LDN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:VICTORIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RD, CSN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 COBBLER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2686
Mailing Address - Country:US
Mailing Address - Phone:203-456-5284
Mailing Address - Fax:
Practice Address - Street 1:281 COBBLER LN
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2686
Practice Address - Country:US
Practice Address - Phone:203-456-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59.002949133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT59.002949OtherSTATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH
86378409OtherCOMMISSION ON DIETETIC REGISTRATION