| Doctor Name: | MS. JENNA RUSSELL DALLINGA |
| NPI Number: | 1053687715 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMT |
| License Number: | 005456 |
| Business Practice Address: | 40 Lake Avenue Ext Danbury, CT - 068115283 |
| Business Phone Number: | 8456129849 |
| Business Fax Number: | |
| Mailing Address: | 103 Harvest Dr, BREWSTER |
| State: | NY |
| Postal Code: | 105093706 |
| Phone Number: | 8456129849 |
| Fax Number: | |
| NPI Enumeration Date: | 03/27/2012 |
| NPI Last Update Date: | 03/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 005456 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |