Provider Demographics
NPI:1073240933
Name:NAVEDO, DOREEN MELISSA
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:MELISSA
Last Name:NAVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 BEDFORD ST APT 11
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4790
Mailing Address - Country:US
Mailing Address - Phone:475-419-4359
Mailing Address - Fax:
Practice Address - Street 1:1544 BEDFORD ST APT 11
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4790
Practice Address - Country:US
Practice Address - Phone:475-419-4359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist