Healthcare Provider Details

I. General information

NPI: 1043032444
Provider Name (Legal Business Name): MELISSA A MOYNIHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CRANBROOK BLVD FL 2
ENFIELD CT
06082-3889
US

IV. Provider business mailing address

50 CONE ST
MANCHESTER CT
06040-4450
US

V. Phone/Fax

Practice location:
  • Phone: 833-538-7464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14124
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: