Most Relevant Information
Provider Data
| NPI Number: | 1003376237 |
| Provider Name: | YE SU DO |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/22/2019 |
| Last Updated: | 04/12/2024 |
Provider Practice Location
80 S MAIN ST STE 101
MIDDLETOWN
CT
064573648
Practice Location Phone/Fax
| Phone: | 8603585970 |
| Fax: | 8603588690 |
Provider Mailing Location
28 CRESCENT ST
MIDDLETOWN
CT
064573650
Provider Mailing Phone/Fax
| Phone: | 8603586000 |
| Fax: |