Healthcare Provider Details

I. General information

NPI: 1316957285
Provider Name (Legal Business Name): DIANE GUARDIANI PMHNP (APRN)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 COPSE RD
MADISON CT
06443-2323
US

IV. Provider business mailing address

175 COPSE RD
MADISON CT
06443-2323
US

V. Phone/Fax

Practice location:
  • Phone: 203-245-2778
  • Fax: 203-245-8603
Mailing address:
  • Phone: 860-908-9894
  • Fax: 203-245-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2409
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number002409
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: