Healthcare Provider Details

I. General information

NPI: 1952853863
Provider Name (Legal Business Name): MAYFLOWER ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 HOPMEADOW ST
SIMSBURY CT
06070-2415
US

IV. Provider business mailing address

536 HOPMEADOW ST
SIMSBURY CT
06070-2415
US

V. Phone/Fax

Practice location:
  • Phone: 860-413-2118
  • Fax: 860-831-0318
Mailing address:
  • Phone: 860-413-2118
  • Fax: 860-831-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number265
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number512
License Number StateCT

VIII. Authorized Official

Name: CHERYL PAINE
Title or Position: OFFICE MANAGER
Credential:
Phone: 860-413-2118