# VALLEY SPORTS PHYSICIANS & ORTHOPEDIC MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Valley Sports Physicians
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871799635
- **Authorized official:** MISS NICHOLE WEDDERBURN (OFFICE / BILLING MANAGER)
- **Authorized official phone:** (860) 675-0357

## Contact information

- **Practice address:** 54 W AVON RD, SUITE 202, AVON, CT 06001-3680
- **Practice address phone:** (860) 675-0357
- **Practice address fax:** (860) 675-0358
- **Mailing address:** 54 W AVON RD, SUITE 202, AVON, CT 06001-3680
- **Mailing address phone:** (860) 675-0357
- **Mailing address fax:** (860) 675-0358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | 000406 | CT | — |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | 040264 | CT | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 000406 | CT | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 040264 | CT | — |

## Other

- **Enumeration date:** 06/26/2007
- **Last updated:** 10/24/2007