Healthcare Provider Details

I. General information

NPI: 1598059297
Provider Name (Legal Business Name): DORETTE F LEWIS-SENIOR ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PLATTSVILLE RD
TRUMBULL CT
06611-3427
US

IV. Provider business mailing address

239 PLATTSVILLE RD
TRUMBULL CT
06611-3427
US

V. Phone/Fax

Practice location:
  • Phone: 203-374-5309
  • Fax: 203-374-6856
Mailing address:
  • Phone: 203-374-5309
  • Fax: 203-374-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number461148
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000302
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: