Provider Demographics
NPI:1710262209
Name:CALLOWAY, NICOLE DUNAY
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DUNAY
Last Name:CALLOWAY
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 1:510 REEF RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6543
Mailing Address - Country:US
Mailing Address - Phone:203-394-8329
Mailing Address - Fax:
Practice Address - Street 1:510 REEF RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824
Practice Address - Country:US
Practice Address - Phone:203-394-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043363174400000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies