Healthcare Provider Details

I. General information

NPI: 1083495378
Provider Name (Legal Business Name): SUANNE SAMARDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 WEST ST STE G
CROMWELL CT
06416-2441
US

IV. Provider business mailing address

160 WEST ST STE G
CROMWELL CT
06416-2441
US

V. Phone/Fax

Practice location:
  • Phone: 860-604-7438
  • Fax: 860-413-0891
Mailing address:
  • Phone: 860-604-7438
  • Fax: 860-413-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12494
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number12494
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: