Healthcare Provider Details

I. General information

NPI: 1184337123
Provider Name (Legal Business Name): WIOLETTA SKRODZKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE
HAMDEN CT
06517-1209
US

IV. Provider business mailing address

150 COUNTRY SQUIRE DR UNIT 4208
CROMWELL CT
06416-2645
US

V. Phone/Fax

Practice location:
  • Phone: 203-848-1803
  • Fax:
Mailing address:
  • Phone: 860-462-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11068
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: