Provider Demographics
NPI:1841826146
Name:GUADARRAMA, TAWANA
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:
Last Name:GUADARRAMA
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 1:405 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3052
Mailing Address - Country:US
Mailing Address - Phone:860-538-7854
Mailing Address - Fax:860-728-3782
Practice Address - Street 1:221 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1890
Practice Address - Country:US
Practice Address - Phone:860-296-6400
Practice Address - Fax:860-728-3782
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker