Individual
STEPHANIE TERESA TISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
120 PARK LANE RD, SUITE A-101, NEW MILFORD, CT 06776-2444
(860) 355-8190
(860) 355-3856
Mailing address
120 PARK LANE RD, SUITE A-101, NEW MILFORD, CT 06776-2444
(860) 355-8190
(860) 355-3856
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
051071
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008041366
—
CT
Enumeration date
05/22/2009
Last updated
09/03/2013
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