Healthcare Provider Details

I. General information

NPI: 1649219551
Provider Name (Legal Business Name): VIRGINIA SYOMBATHY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WHITNEY AVENUE SUITE 240
HAMDEN CT
06518
US

IV. Provider business mailing address

19 LUNAR DRIVE
WOODBRIDGE CT
06525
US

V. Phone/Fax

Practice location:
  • Phone: 203-407-8002
  • Fax: 203-407-8038
Mailing address:
  • Phone: 203-389-7504
  • Fax: 203-389-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number002952
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number002952
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number002952
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: