Healthcare Provider Details

I. General information

NPI: 1558914648
Provider Name (Legal Business Name): ADEY ABEBE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GERMANTOWN RD
DANBURY CT
06810-5036
US

IV. Provider business mailing address

25 GERMANTOWN RD
DANBURY CT
06810-5036
US

V. Phone/Fax

Practice location:
  • Phone: 203-794-5620
  • Fax:
Mailing address:
  • Phone: 203-794-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number689838
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344942
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8473
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: