Healthcare Provider Details

I. General information

NPI: 1235535584
Provider Name (Legal Business Name): STACY SANZONE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CRESCENT ST
MIDDLETOWN CT
06457-3654
US

IV. Provider business mailing address

198 SCARBOROUGH LN
MIDDLETOWN CT
06457-7543
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-6000
  • Fax:
Mailing address:
  • Phone: 203-803-8295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005989
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5989
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: