Provider Demographics
NPI:1326592999
Name:MAGALHAES, JENNIFER IRIS (MED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IRIS
Last Name:MAGALHAES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:IRIS
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 HAMILTON ST
Mailing Address - Street 2:UNITED STATES
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2983
Mailing Address - Country:US
Mailing Address - Phone:860-578-1300
Mailing Address - Fax:
Practice Address - Street 1:237 HAMILTON ST
Practice Address - Street 2:UNITED STATES
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2983
Practice Address - Country:US
Practice Address - Phone:860-578-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC102012001039390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program