Provider Demographics
NPI:1730584798
Name:DIFAZIO, JILLIAN (DVM, DACVECC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:DIFAZIO
Suffix:
Gender:F
Credentials:DVM, DACVECC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-6968
Mailing Address - Country:US
Mailing Address - Phone:203-595-2777
Mailing Address - Fax:
Practice Address - Street 1:880 CANAL ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-6968
Practice Address - Country:US
Practice Address - Phone:203-595-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4006174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian