Provider Demographics
NPI:1801599295
Name:THE MODERN WOMAN HEALTH & WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:THE MODERN WOMAN HEALTH & WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBRAMANI-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-FNPC
Authorized Official - Phone:203-725-5339
Mailing Address - Street 1:504 WOLCOTT RD STE C
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2462
Mailing Address - Country:US
Mailing Address - Phone:203-504-9507
Mailing Address - Fax:
Practice Address - Street 1:504 WOLCOTT RD STE C
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2462
Practice Address - Country:US
Practice Address - Phone:203-504-9507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty