Healthcare Provider Details

I. General information

NPI: 1568086726
Provider Name (Legal Business Name): MRS. DORIS SIAWOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 04/28/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WEST JOHNSON AVE
CHESHIRE CT
06410-4531
US

IV. Provider business mailing address

615 W JOHNSON AVE
CHESHIRE CT
06410-4532
US

V. Phone/Fax

Practice location:
  • Phone: 866-888-7610
  • Fax:
Mailing address:
  • Phone: 866-888-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA8435119
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: