Healthcare Provider Details

I. General information

NPI: 1659150597
Provider Name (Legal Business Name): TENNESHA LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 WHITE PLAINS RD STE 203B
TRUMBULL CT
06611-4547
US

IV. Provider business mailing address

935 WHITE PLAINS RD STE 203B
TRUMBULL CT
06611-4547
US

V. Phone/Fax

Practice location:
  • Phone: 203-616-2255
  • Fax: 203-504-9639
Mailing address:
  • Phone: 203-616-2255
  • Fax: 203-504-9639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberHCA.0002269
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: