Healthcare Provider Details

I. General information

NPI: 1427753631
Provider Name (Legal Business Name): STEPHANIE ROSE GIDICSIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HIGHLAND AVE STE 110
CHESHIRE CT
06410-2583
US

IV. Provider business mailing address

435 HIGHLAND AVE STE 110
CHESHIRE CT
06410-2583
US

V. Phone/Fax

Practice location:
  • Phone: 203-272-0396
  • Fax: 203-272-0052
Mailing address:
  • Phone: 203-272-0396
  • Fax: 203-272-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84389
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: