Healthcare Provider Details

I. General information

NPI: 1437170495
Provider Name (Legal Business Name): DENISE L SIKORSKI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 POMFRET ST
PUTNAM CT
06260-1871
US

IV. Provider business mailing address

320 POMFRET ST
PUTNAM CT
06260-1836
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-4344
  • Fax: 860-928-4188
Mailing address:
  • Phone: 860-928-6541
  • Fax: 860-963-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000759
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: