Healthcare Provider Details

I. General information

NPI: 1417060468
Provider Name (Legal Business Name): MATTHEW L FISEL ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 DUNK ROCK RD
GUILFORD CT
06437-2509
US

IV. Provider business mailing address

12 RAYNHAM RD
NEW HAVEN CT
06512-5013
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-0122
  • Fax: 203-458-1017
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000279
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: