Provider Demographics
NPI:1609227537
Name:CZUCZKA, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CZUCZKA
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 1:3 POSSUM RUN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1901
Mailing Address - Country:US
Mailing Address - Phone:917-692-3563
Mailing Address - Fax:
Practice Address - Street 1:3 POSSUM RUN
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-1901
Practice Address - Country:US
Practice Address - Phone:917-692-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL-96799174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN