Provider Demographics
NPI:1558751313
Name:MCDUFFIE, JANIS
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:MCDUFFIE
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 1:5065 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4204
Mailing Address - Country:US
Mailing Address - Phone:203-873-2014
Mailing Address - Fax:203-873-2024
Practice Address - Street 1:5065 MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4204
Practice Address - Country:US
Practice Address - Phone:203-873-2014
Practice Address - Fax:203-873-2024
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPTN.0001272247200000X
CT190101902519738247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other