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General NPI Number Information
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NPI Number | 1881490464
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Entity Type | Individual
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Provider Name | DR. MAIREAD ELIZABETH ROSA
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 66 GLENBROOK RD STE 100
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City | STAMFORD
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State | CT
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Zip | 06902-8402
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Country | US
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Telephone | 203-978-1100
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Fax | 203-967-7226
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Provider Business Mailing Address
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Address Line | 52 SHEARER RD
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City | WASHINGTON
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State | CT
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Zip | 06793-1009
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Country | US
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Telephone | 860-866-6154
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2348
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License Number State | CT
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