Healthcare Provider Details

I. General information

NPI: 1174801682
Provider Name (Legal Business Name): JEFFREY M RANAUDO M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 TOLLAND TPKE STE 1A
MANCHESTER CT
06042-1759
US

IV. Provider business mailing address

6 RESEARCH DR STE 105
SHELTON CT
06484-6228
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-6551
  • Fax: 203-502-2615
Mailing address:
  • Phone: 203-210-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number53967
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number53967
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: