Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 2206 | CT |
NPI | 1538765755 |
---|---|
Provider Name | Shanise Fleming |
First Address | Coventry, CT 06238-1516 |
Second Address | Marlborough, CT 06447-1408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2020 |
Last Update Date | 11/12/2020 |