Provider Demographics
NPI:1366216665
Name:MAJOR, MANDY (PCD)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:MAJOR
Suffix:
Gender:F
Credentials:PCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-0469
Mailing Address - Country:US
Mailing Address - Phone:860-459-4732
Mailing Address - Fax:
Practice Address - Street 1:99 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:KILLINGWORTH
Practice Address - State:CT
Practice Address - Zip Code:06419-1328
Practice Address - Country:US
Practice Address - Phone:860-452-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13509374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula