Healthcare Provider Details

I. General information

NPI: 1801198411
Provider Name (Legal Business Name): NADIA TRACEY PHILLIPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 NEWTOWN RD STE 3
DANBURY CT
06810-6238
US

IV. Provider business mailing address

15 BATES PL APT 6
DANBURY CT
06810-6074
US

V. Phone/Fax

Practice location:
  • Phone: 860-452-1158
  • Fax:
Mailing address:
  • Phone: 860-452-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17239
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number632441-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: