Healthcare Provider Details

I. General information

NPI: 1376940635
Provider Name (Legal Business Name): MRS. LESLEY NICOLE CHARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BROAD STREET SUITE C3
MILFORD CT
06460
US

IV. Provider business mailing address

203 BROAD STREET SUITE C3
MILFORD CT
06460
US

V. Phone/Fax

Practice location:
  • Phone: 203-871-1953
  • Fax: 475-275-7232
Mailing address:
  • Phone: 203-871-1953
  • Fax: 475-275-7232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5995
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: