Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 042516 | CT |
NPI | 1215970215 |
---|---|
Provider Name | Sherlet A Kurian |
First Address | Branford, CT 06405-2918 |
Second Address | Branford, CT 06405-2918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001425166 | (05) | CT |
01283R | (02) | CT |