Healthcare Provider Details

I. General information

NPI: 1023797016
Provider Name (Legal Business Name): COLLEEN BOZENA SVYSTUN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS COLLEEN BOZENA PADYKULA

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 MAIN ST STE 212
MANCHESTER CT
06040-6064
US

IV. Provider business mailing address

945 MAIN ST STE 212
MANCHESTER CT
06040-6064
US

V. Phone/Fax

Practice location:
  • Phone: 860-967-4495
  • Fax:
Mailing address:
  • Phone: 860-649-6166
  • Fax: 860-649-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12195
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number154455
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: