Individual provider Active NPI

Edyth Layng McClure, R.D., C.D.E.

  • Metabolic Nutrition Registered Dietitian
  • Southbury, CT
National Provider Identifier
1437262102
Registry record updated Feb 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X
Practice address
94 Fox Run Dr
Southbury, CT 06488-4408
Phone
(203) 267-4090
Fax
(203) 267-4057
NPI assigned
Aug 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Metabolic Nutrition Registered Dietitian 133VN1006X Primary

Addresses

Primary practice location

94 Fox Run Dr
Southbury, CT 06488-4408

Mailing address

94 Fox Run Drive
Southbury, CT 06488
Phone (203) 267-4090

Other practice location 1

3150 Hugh Bennett Dr
Johns Island, SC 29455-3473
Phone (203) 586-9136

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050203000422 CT Practitioner - Registered Dietitian Or Nutrition Professional 2062463334 Practice locations: Southbury, CT

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

94 Fox Run Dr
Southbury, CT 06488-4408
Phone (203) 267-4090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
000524CTMDWomen's Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708819200000",
    "number": "1437262102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 FOX RUN DRIVE",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "06488",
            "telephone_number": "203-267-4090",
            "fax_number": "203-267-4057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 FOX RUN DR",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064884408",
            "telephone_number": "203-267-4090",
            "fax_number": "203-267-4057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3150 Hugh Bennett Dr",
            "address_purpose": "LOCATION",
            "city": "Johns Island",
            "state": "SC",
            "postal_code": "294553473",
            "country_code": "US",
            "telephone_number": "203-586-9136",
            "fax_number": "203-267-4057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCLURE",
        "first_name": "EDYTH",
        "middle_name": "LAYNG",
        "name_prefix": "Ms.",
        "credential": "R.D., C.D.E.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.