Healthcare Provider Details

I. General information

NPI: 1578021416
Provider Name (Legal Business Name): CHRISTINA LYNN CAULIFFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GREENWICH OFFICE PARK
GREENWICH CT
06831-5151
US

IV. Provider business mailing address

6 GREENWICH OFFICE PARK
GREENWICH CT
06831-5151
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-1145
  • Fax: 203-869-4246
Mailing address:
  • Phone: 203-869-1145
  • Fax: 203-869-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1222
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: