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Tanisha Clark
NPI 1871095935 · on the registry since 2018 · sole proprietor
Practice
- Address
- 333 Christian St
Wallingford, CT 06492 - Phone
- (203) 697-2983
- Organisation at this address
- Choate Rosemary Hall Foundation
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 8
Additional practice sites
- 541 Main St, New London, NH
Registry record
- Primary taxonomy
- 2255A2300X
2255A2300X
- Also registered as
- 390200000X
2255A2300X - Licence states on file
- CT
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2021-02-15
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