Healthcare Provider Details

I. General information

NPI: 1275830739
Provider Name (Legal Business Name): STARRY BROOK NATURAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SOUTH RD
DEERFIELD NH
03037
US

IV. Provider business mailing address

14 BOW ST
EXETER NH
03833-2828
US

V. Phone/Fax

Practice location:
  • Phone: 603-583-5181
  • Fax: 844-364-9449
Mailing address:
  • Phone: 603-583-5181
  • Fax: 603-583-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number82
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number82
License Number StateNH

VIII. Authorized Official

Name: DR. ROBYN GIARD
Title or Position: OWNER
Credential: ND
Phone: 603-583-5181