Healthcare Provider Details

I. General information

NPI: 1215609409
Provider Name (Legal Business Name): LINDA ZABANEH RN, BSN, ICN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MILL PLAIN RD
FAIRFIELD CT
06824-5048
US

IV. Provider business mailing address

400 MILL PLAIN RD
FAIRFIELD CT
06824-5048
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-3573
  • Fax:
Mailing address:
  • Phone: 203-255-3573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number90862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: