Provider Demographics
NPI:1043646789
Name:BLAIR, CAROLINE S (AUD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:S
Last Name:BLAIR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:S
Other - Last Name:SHILLITOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:32 STRAWBERRY HILL COURT
Mailing Address - Street 2:SUITE 4
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-353-0000
Mailing Address - Fax:203-357-8109
Practice Address - Street 1:32 STRAWBERRY HILL CT.
Practice Address - Street 2:SUITE 4
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-353-0000
Practice Address - Fax:203-357-8109
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program