Healthcare Provider Details

I. General information

NPI: 1063330009
Provider Name (Legal Business Name): DANIELLE MARIE MONTESANTO APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MAIN ST
MIDDLETOWN CT
06457-2732
US

IV. Provider business mailing address

675 MAIN ST
MIDDLETOWN CT
06457-2732
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax:
Mailing address:
  • Phone: 860-347-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17839
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: