Healthcare Provider Details

I. General information

NPI: 1982408522
Provider Name (Legal Business Name): JOANA LALAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 KING ST
BRISTOL CT
06010-9207
US

IV. Provider business mailing address

156 QUEEN ST
BRISTOL CT
06010-5853
US

V. Phone/Fax

Practice location:
  • Phone: 323-217-6662
  • Fax:
Mailing address:
  • Phone: 323-217-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3404
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: