Provider Demographics
NPI:1912303017
Name:BRONNER, TAUHEEDAH (ND)
Entity type:Individual
Prefix:DR
First Name:TAUHEEDAH
Middle Name:
Last Name:BRONNER
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 1:118 HAUT BRION AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4536
Mailing Address - Country:US
Mailing Address - Phone:302-832-9472
Mailing Address - Fax:
Practice Address - Street 1:118 HAUT BRION AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4536
Practice Address - Country:US
Practice Address - Phone:302-832-9472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000517175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath