MEDICARE: CHRISTINA FANTONI MSN, CNM

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	176B00000X	Midwife	000662-1	NY
2	367A00000X	Advanced Practice Midwife	000179	CT

General Provider Information

NPI Number	:	1194727404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA FANTONI MSN, CNM

Provider Business Mailing Address
First Line	:	345 WHITNEY AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-2348
Country	:	US
Telephone Number	:	203-752-2856
Fax Number	:	203-752-8785

Provider Business Practice Location Address
First Line	:	263 MAIN ST
Second Line	:
City	:	OLD SAYBROOK
State	:	CT
Zip	:	06475-2326
Country	:	US
Telephone Number	:	860-388-8445
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/14/2023

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