Healthcare Provider Details

I. General information

NPI: 1265359756
Provider Name (Legal Business Name): ALICE M MADAZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WOODWARD ST
KILLINGLY CT
06239-1644
US

IV. Provider business mailing address

129 WOODWARD ST
KILLINGLY CT
06239-1644
US

V. Phone/Fax

Practice location:
  • Phone: 508-371-8180
  • Fax:
Mailing address:
  • Phone: 508-371-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.017729
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: