Healthcare Provider Details

I. General information

NPI: 1396394722
Provider Name (Legal Business Name): BARBARA J MAZZARA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 11/30/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 LEWIS AVE
MERIDEN CT
06451-2101
US

IV. Provider business mailing address

101 N PLAINS INDUSTRIAL RD STE 4
WALLINGFORD CT
06492-5835
US

V. Phone/Fax

Practice location:
  • Phone: 203-949-2700
  • Fax: 203-949-2712
Mailing address:
  • Phone: 203-949-2700
  • Fax: 203-949-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberPENDING
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: