Healthcare Provider Details

I. General information

NPI: 1285400804
Provider Name (Legal Business Name): ALEXA LOMBARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410C SAYBROOK RD
MIDDLETOWN CT
06457-4776
US

IV. Provider business mailing address

410C SAYBROOK RD
MIDDLETOWN CT
06457-4776
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-2970
  • Fax: 860-347-1630
Mailing address:
  • Phone: 860-358-2970
  • Fax: 860-347-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023152083
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: