Provider Demographics
NPI:1194914994
Name:CICERO, CEYLON MARIE (ND)
Entity type:Individual
Prefix:MISS
First Name:CEYLON
Middle Name:MARIE
Last Name:CICERO
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 1:31 TOBEY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3521
Mailing Address - Country:US
Mailing Address - Phone:860-951-8308
Mailing Address - Fax:860-243-0652
Practice Address - Street 1:31 TOBEY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3521
Practice Address - Country:US
Practice Address - Phone:860-951-8308
Practice Address - Fax:860-243-0652
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00355175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath