Healthcare Provider Details

I. General information

NPI: 1174973812
Provider Name (Legal Business Name): AMANDA RACHEL WEINBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 WHITNEY AVE
HAMDEN CT
06517-1425
US

IV. Provider business mailing address

212 REGIS DR
MERIDEN CT
06450-8151
US

V. Phone/Fax

Practice location:
  • Phone: 203-848-1803
  • Fax:
Mailing address:
  • Phone: 860-301-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6562
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: