Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 14.013098-TEMP | CT |
Y | 213ES0000X | Sports Medicine | 14.013098-TEMP | CT |
NPI | 1548830698 |
---|---|
Provider Name | Amanda Jane Zdun |
First Address | Weatogue, CT 06089-9782 |
Second Address | Weatogue, CT 06089-9782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2021 |
Last Update Date | 30/06/2021 |