Provider Demographics
NPI:1053718486
Name:MACHIN, SALLY ELIZABETH (ND)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ELIZABETH
Last Name:MACHIN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SIMSBURY RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3793
Mailing Address - Country:US
Mailing Address - Phone:860-674-0111
Mailing Address - Fax:860-677-5406
Practice Address - Street 1:100 SIMSBURY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3793
Practice Address - Country:US
Practice Address - Phone:860-674-0111
Practice Address - Fax:860-677-5406
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT534175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath