Healthcare Provider Details

I. General information

NPI: 1154187151
Provider Name (Legal Business Name): MS. CASSANDRA KRIZIA MAE LUMUCSO ZAPANTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MELROSE AVE STE 206
GREENWICH CT
06830-6277
US

IV. Provider business mailing address

439 FAIRVIEW AVE FL 1
BRIDGEPORT CT
06606-4602
US

V. Phone/Fax

Practice location:
  • Phone: 860-897-6235
  • Fax:
Mailing address:
  • Phone: 860-897-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197682
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: