Provider Demographics
NPI:1699212969
Name:SOUSA CARDOSO, STEPHANIE (ND)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SOUSA CARDOSO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4124
Mailing Address - Country:US
Mailing Address - Phone:203-431-1688
Mailing Address - Fax:
Practice Address - Street 1:10 SOUTH ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4124
Practice Address - Country:US
Practice Address - Phone:203-431-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000584175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath