Healthcare Provider Details

I. General information

NPI: 1700796661
Provider Name (Legal Business Name): MIA LLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 JOHNSON ST APT 201
BRIDGEPORT CT
06604-5822
US

IV. Provider business mailing address

74 JOHNSON ST APT 201
BRIDGEPORT CT
06604-5822
US

V. Phone/Fax

Practice location:
  • Phone: 203-343-5165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number24895573
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: