Healthcare Provider Details

I. General information

NPI: 1609647221
Provider Name (Legal Business Name): BLUES AND BLAHS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 BERWYN ST
MILFORD CT
06461-4010
US

IV. Provider business mailing address

38 BERWYN ST
MILFORD CT
06461-4010
US

V. Phone/Fax

Practice location:
  • Phone: 203-571-3233
  • Fax: 801-752-0632
Mailing address:
  • Phone: 203-571-3233
  • Fax: 801-752-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. NELSON LEACH
Title or Position: OWNER
Credential: APRN
Phone: 203-571-3233