Healthcare Provider Details

I. General information

NPI: 1114837226
Provider Name (Legal Business Name): CLAUDINE THERESA MUNDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5151 PARK AVE
FAIRFIELD CT
06825-1000
US

IV. Provider business mailing address

76 MILL POND CIR
GROTON CT
06340-7705
US

V. Phone/Fax

Practice location:
  • Phone: 774-272-1535
  • Fax:
Mailing address:
  • Phone: 774-272-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number89533
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: