Healthcare Provider Details

I. General information

NPI: 1750866778
Provider Name (Legal Business Name): MICHAEL JOSEPH DEMASI DNP, FNP-BC, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 PARK AVE
BRIDGEPORT CT
06604-4619
US

IV. Provider business mailing address

725 PARK AVE SAGE HEALTHCARE WITHIN BRIDGEPORT RESCUE MISSION
BRIDGEPORT CT
06604-4619
US

V. Phone/Fax

Practice location:
  • Phone: 203-916-0862
  • Fax: 888-571-6304
Mailing address:
  • Phone: 203-916-0862
  • Fax: 888-571-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7857
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: