Healthcare Provider Details

I. General information

NPI: 1659401735
Provider Name (Legal Business Name): TIFFANY DAWN LABELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BREWSTER RD
BRISTOL CT
06010-5161
US

IV. Provider business mailing address

PO BOX 2828
BRISTOL CT
06011-2828
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-3950
  • Fax:
Mailing address:
  • Phone: 860-585-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number049905
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: