Healthcare Provider Details

I. General information

NPI: 1396629887
Provider Name (Legal Business Name): EMMA R RANDAZZO NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

53 INDIAN DR
MANCHESTER CT
06042-3405
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9720
  • Fax:
Mailing address:
  • Phone: 860-262-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number15194
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number12.015194
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: