Healthcare Provider Details

I. General information

NPI: 1861419558
Provider Name (Legal Business Name): MAYUMI KAH WAH DERANEY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GLEN RD
SANDY HOOK CT
06482-1124
US

IV. Provider business mailing address

24 GLEN RD
SANDY HOOK CT
06482-1124
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-6334
  • Fax: 203-426-3070
Mailing address:
  • Phone: 203-426-6334
  • Fax: 203-426-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001683
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: