Provider Demographics
NPI:1871931329
Name:MCINTYRE, JAMIE LEE (MS RD CD-N)
Entity type:Individual
Prefix:MRS
First Name:JAMIE LEE
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MS RD CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-2651
Mailing Address - Country:US
Mailing Address - Phone:203-240-0321
Mailing Address - Fax:
Practice Address - Street 1:7005 HANCOCK DR
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-2651
Practice Address - Country:US
Practice Address - Phone:203-240-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001019133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered