Healthcare Provider Details

I. General information

NPI: 1619482510
Provider Name (Legal Business Name): FAUSTINA SERWAH AGYAPONG APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CENTERPOINT DR STE 215
MIDDLETOWN CT
06457-7568
US

IV. Provider business mailing address

33 DIXWELL AVE # 312
NEW HAVEN CT
06511-3403
US

V. Phone/Fax

Practice location:
  • Phone: 888-964-6681
  • Fax: 888-662-0859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7400
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7400
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: