Provider Demographics
NPI:1669738084
Name:RAISSI-SADEGHI, GOLNAR (ND)
Entity type:Individual
Prefix:
First Name:GOLNAR
Middle Name:
Last Name:RAISSI-SADEGHI
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 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:SUITE 11
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-276-5949
Mailing Address - Fax:203-276-4097
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:SUITE 11
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-276-5949
Practice Address - Fax:203-276-4097
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000444171100000X, 175F00000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
No175L00000XOther Service ProvidersHomeopath