Provider Demographics
NPI:1225750474
Name:UNCLOGGED WELLS, LLC
Entity Type:Organization
Organization Name:UNCLOGGED WELLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENSHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PREVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:203-252-9859
Mailing Address - Street 1:127 GREYROCK PL APT 704
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3107
Mailing Address - Country:US
Mailing Address - Phone:203-252-9859
Mailing Address - Fax:
Practice Address - Street 1:127 GREYROCK PL APT 704
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3107
Practice Address - Country:US
Practice Address - Phone:203-252-9859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty