Individual
MONIQUE TYSHAE PETTWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
259 LIGHT ST, STRATFORD, CT 06614-5233
(203) 212-7810
Mailing address
259 LIGHT ST, STRATFORD, CT 06614-5233
(203) 212-7810
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
141436
CT
Other
Enumeration date
08/11/2026
Last updated
08/11/2026
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