Provider Demographics
NPI:1417060468
Name:FISEL, MATTHEW L (ND)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
Last Name:FISEL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RAYNHAM RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-5013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 DUNK ROCK RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2509
Practice Address - Country:US
Practice Address - Phone:203-453-0122
Practice Address - Fax:203-458-1017
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000279175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath