Healthcare Provider Details

I. General information

NPI: 1043793565
Provider Name (Legal Business Name): NAYA D AGODOA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 N MAIN ST
BRISTOL CT
06010-4924
US

IV. Provider business mailing address

395 N MAIN ST
BRISTOL CT
06010-4924
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-5000
  • Fax:
Mailing address:
  • Phone: 860-585-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7843
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: