=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225644271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNDSEY MICHELE MAHER ND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2020
-----------------------------------------------------
Last Update Date | 10/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2661 WHITNEY AVE
-----------------------------------------------------
City | HAMDEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06518-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-871-3262
-----------------------------------------------------
Fax | 203-868-0698
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 ROCKY RIDGE RD
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06612-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-494-4433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 666
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------