Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 000990 | CT |
Y | 213ES0000X | Sports Medicine | 000990 | CT |
NPI | 1568078764 |
---|---|
Provider Name | Miss Sydney Marie Judkins |
First Address | Stratford, CT 06615-7539 |
Second Address | Fairfield, CT 06824-6019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2020 |
Last Update Date | 22/09/2020 |