Provider Demographics
NPI:1598927634
Name:RUDICH, DANIELLE SYLVIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:SYLVIE
Last Name:RUDICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3105
Practice Address - Country:US
Practice Address - Phone:203-597-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51746207W00000X, 207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology