Provider Demographics
NPI:1457851131
Name:ROOT, DEVON LEIGH
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:LEIGH
Last Name:ROOT
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 1:14 FORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST CORNWALL
Mailing Address - State:CT
Mailing Address - Zip Code:06796-1320
Mailing Address - Country:US
Mailing Address - Phone:860-480-0345
Mailing Address - Fax:
Practice Address - Street 1:21 LEDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1664
Practice Address - Country:US
Practice Address - Phone:860-771-6956
Practice Address - Fax:860-771-6956
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife