Most Relevant Information
Provider Data
| NPI Number: | 1003502097 |
| Provider Name: | SHONDA M NORTHUP |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/13/2023 |
| Last Updated: | 04/13/2023 |
Provider Practice Location
71 WESTCOTT RD
DANIELSON
CT
062392929
Practice Location Phone/Fax
| Phone: | 8607315522 |
| Fax: | 8607315536 |
Provider Mailing Location
2 WATERSIDE XING STE 401
WINDSOR
CT
060951588
Provider Mailing Phone/Fax
| Phone: | 8606973351 |
| Fax: | 8607315536 |