Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 001372 | CT |
NPI | 1548377989 |
---|---|
Provider Name | Dr. Shari A Roguski |
First Address | Madison, CT 06443-0373 |
Second Address | Madison, CT 06443-2674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050001372CT01 | BLUE CROSS (01) | CT |
061604608 & 4404636 | UNITED HEALTH CARE (01) | CT |
U84669 | (02) | CT |