Healthcare Provider Details

I. General information

NPI: 1962290924
Provider Name (Legal Business Name): BALANCED WOMEN'S WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 STANAVAGE RD
COLCHESTER CT
06415-2033
US

IV. Provider business mailing address

220 STANAVAGE RD
COLCHESTER CT
06415-2033
US

V. Phone/Fax

Practice location:
  • Phone: 860-367-2691
  • Fax: 860-600-9885
Mailing address:
  • Phone: 860-367-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: TANYA SMITH
Title or Position: PROVIDER/OWNER
Credential: CNM, MSCP
Phone: 860-367-2691