Provider Demographics
NPI:1780811562
Name:MALENDA, STEVEN (LO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MALENDA
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 NEW HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4731
Mailing Address - Country:US
Mailing Address - Phone:203-720-2395
Mailing Address - Fax:203-720-2863
Practice Address - Street 1:1060 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4731
Practice Address - Country:US
Practice Address - Phone:203-720-2395
Practice Address - Fax:203-720-2863
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1305156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician