Provider Demographics
NPI:1861419558
Name:DERANEY, MAYUMI KAH WAH (DC)
Entity type:Individual
Prefix:DR
First Name:MAYUMI
Middle Name:KAH WAH
Last Name:DERANEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1124
Mailing Address - Country:US
Mailing Address - Phone:203-426-6334
Mailing Address - Fax:203-426-3070
Practice Address - Street 1:24 GLEN RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1124
Practice Address - Country:US
Practice Address - Phone:203-426-6334
Practice Address - Fax:203-426-3070
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor