Provider Demographics
NPI:1760969133
Name:DELEON, TIFFANY NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:NICOLE
Last Name:DELEON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-2924
Mailing Address - Country:US
Mailing Address - Phone:203-510-7339
Mailing Address - Fax:
Practice Address - Street 1:58 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4160
Practice Address - Country:US
Practice Address - Phone:203-729-2226
Practice Address - Fax:203-729-2227
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3096152W00000X
NYT008848152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist