Provider Information for 1013566397
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SUSAN ESTRELA
Sex: Female
NPI: 1013566397
Last Updated: 2024-11-25
Certification Date: 2024-11-25
Certification Date: 2024-11-25
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1013566397 | ||||||||||||||||
| Enumeration Date | 2019-09-09 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | PO BOX 1595 MIDDLETOWN, CT 06457-8095 United States Phone: 607-886-4048 | Fax: | ||||||||||||||||
| Primary Practice Address | 290 KENYON AVE PAWTUCKET, RI 02861-1112 United States Phone: 401-632-6434 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 222 JEFFERSON BLVD STE 200 84 STATE ST | ||||||||||||||||
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