Provider Demographics
NPI:1104961168
Name:GUIDA, LYNNETTE MICHELLE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:MICHELLE
Last Name:GUIDA
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 NEWFIELD ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1867
Mailing Address - Country:US
Mailing Address - Phone:860-347-8800
Mailing Address - Fax:860-347-8801
Practice Address - Street 1:670 NEWFIELD ST
Practice Address - Street 2:UNIT C
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1867
Practice Address - Country:US
Practice Address - Phone:860-347-8800
Practice Address - Fax:860-347-8801
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000321171100000X
CT000280175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000280OtherCT NATUROPATHIC LICENSE N
CT691926OtherCONNECTICARE PROVIDER ID
CT110000280CT02OtherANTHEM PROVIDER ID NUMBER
CT000321OtherCT ACUPUNCTURIST LICENSE