Healthcare Provider Details

I. General information

NPI: 1790659977
Provider Name (Legal Business Name): STEPHANIE GESUALDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE HOLDA

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4697 MAIN ST
BRIDGEPORT CT
06606-1869
US

IV. Provider business mailing address

35 BARNEY ST
RUMFORD RI
02916-1201
US

V. Phone/Fax

Practice location:
  • Phone: 203-366-0664
  • Fax:
Mailing address:
  • Phone: 203-710-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15482
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: