Provider Demographics
NPI:1538299151
Name:STAMATAKIS, ANNE HUGHES (LMT, CHTP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:HUGHES
Last Name:STAMATAKIS
Suffix:
Gender:F
Credentials:LMT, CHTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NEW BRITAIN AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1100
Mailing Address - Country:US
Mailing Address - Phone:860-808-8264
Mailing Address - Fax:
Practice Address - Street 1:21 NEW BRITAIN AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1100
Practice Address - Country:US
Practice Address - Phone:860-808-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist