Healthcare Provider Details

I. General information

NPI: 1255252599
Provider Name (Legal Business Name): JODY TING LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 N MAIN ST STE 5
BRANFORD CT
06405-3044
US

IV. Provider business mailing address

144 N MAIN ST STE 5
BRANFORD CT
06405-3044
US

V. Phone/Fax

Practice location:
  • Phone: 203-468-9775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: