MEDICARE: MRS. SHERYL MARINONE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	001729	CT

General Provider Information

NPI Number	:	1093780256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERYL MARINONE APRN

Provider Business Mailing Address
First Line	:	29 MARION ST
Second Line	:
City	:	WINDSOR LOCKS
State	:	CT
Zip	:	06096-2703
Country	:	US
Telephone Number	:	860-623-6649
Fax Number	:

Provider Business Practice Location Address
First Line	:	3A PASCO DR
Second Line	:
City	:	EAST WINDSOR
State	:	CT
Zip	:	06088-1700
Country	:	US
Telephone Number	:	860-623-4100
Fax Number	:	860-623-4101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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