Healthcare Provider Details

I. General information

NPI: 1003746728
Provider Name (Legal Business Name): JEANNE FANIZZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 OLD GATE LN
MILFORD CT
06460-8621
US

IV. Provider business mailing address

278 OLD GATE LN # 306
MILFORD CT
06460-8621
US

V. Phone/Fax

Practice location:
  • Phone: 475-449-1558
  • Fax:
Mailing address:
  • Phone: 475-449-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number000266548
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: