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Tyrone Craddock
NPI 1205472396 · on the registry since 2019 · sole proprietor
Practice
- Address
- 47 Woodlawn Ave
Bridgeport, CT 06606 - Phone
- (860) 600-3132
- Organisation at this address
- My Personal Driver
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 347C00000X
347C00000X
- Also registered as
- 172A00000X
- Licence states on file
- FL, CT
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-11-23
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Connecticut