Healthcare Provider Details

I. General information

NPI: 1821656190
Provider Name (Legal Business Name): DEANNA NARDELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SARGENT DR
NEW HAVEN CT
06511-6100
US

IV. Provider business mailing address

789 HOWARD AVE BLDG BASEMENT
NEW HAVEN CT
06519-1304
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7411
  • Fax:
Mailing address:
  • Phone: 203-688-2475
  • Fax: 203-785-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT217806
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70169
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: