Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 000408 | CT |
NPI | 1154561777 |
---|---|
Provider Name | Medeya Tsnobiladze |
First Address | Norwalk, CT 06855-1315 |
Second Address | Norwalk, CT 06855-1315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2009 |
Last Update Date | 12/08/2010 |