MEDICARE: SHERIFA BELLO MSN

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	363LG0600X	Gerontology Nurse Practitioner	0197234	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0197234	OTHER	CT	AANP

General Provider Information

NPI Number	:	1720599541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERIFA BELLO MSN

Provider Business Mailing Address
First Line	:	1333 BURNSIDE AVE APT A3
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-1517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 BURNSIDE AVE APT A3
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-1517
Country	:	US
Telephone Number	:	860-712-5949
Fax Number	:

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

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	10/19/2017

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