MEDICARE: MS. STEFANIE ANNE GENERAO NP

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	363LC0200X	Critical Care Medicine Nurse Practitioner	15702	CA
2	363LF0000X	Family Nurse Practitioner	8794	CT

General Provider Information

NPI Number	:	1093798860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEFANIE ANNE GENERAO NP

Provider Business Mailing Address
First Line	:	300 GEORGE ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-6624
Country	:	US
Telephone Number	:	916-817-6202
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 GEORGE ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-6624
Country	:	US
Telephone Number	:	916-734-5538
Fax Number	:

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

Provider Enumeration Date	:	11/24/2005
Last Update Date	:	10/06/2020

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