Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 050744 | CT |
N | 2080P0204X | Pediatric Emergency Doctor | 050744 | CT |
NPI | 1295960854 |
---|---|
Provider Name | Ms. Danielle P Federico |
First Address | Avon, CT 06001-2520 |
Second Address | Waterbury, CT 06706-1253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 01/03/2016 |