NPI 1205472396

Tyrone Craddock

Practitioner Private Vehicle Bridgeport, CT

Practice location

Address: 47 Woodlawn Ave, Bridgeport, CT 06606-2962
Phone: (860) 600-3132

Registered specialties (2)

Private Vehicle Primary

Transportation Services Taxonomy 347C00000X Licence 347C00000X (CT)

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Driver

Other Service Providers Taxonomy 172A00000X Licence 347C00000X (FL)

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Registry record

NPI: 1205472396
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Nov 2019
Record last updated: 23 Nov 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.