Healthcare Provider Details

I. General information

NPI: 1700720448
Provider Name (Legal Business Name): FELICIA VIEIRA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

339 FLANDERS RD STE 107
EAST LYME CT
06333-1729
US

IV. Provider business mailing address

339 FLANDERS RD STE 107
EAST LYME CT
06333-1729
US

V. Phone/Fax

Practice location:
  • Phone: 401-965-4436
  • Fax: 860-739-1844
Mailing address:
  • Phone: 401-965-4436
  • Fax: 860-739-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number912
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: