Provider Demographics
NPI:1154583748
Name:BOUTAEVA, ZINAIDA (MD)
Entity type:Individual
Prefix:
First Name:ZINAIDA
Middle Name:
Last Name:BOUTAEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6232 AVALON DR W
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3679
Mailing Address - Country:US
Mailing Address - Phone:203-908-3138
Mailing Address - Fax:
Practice Address - Street 1:6232 AVALON DR W
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3679
Practice Address - Country:US
Practice Address - Phone:203-908-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0463502084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry