Healthcare Provider Details

I. General information

NPI: 1386525012
Provider Name (Legal Business Name): MATTHEW CUCURELLO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 PROSPECT ST APT 2
NEW HAVEN CT
06511-2153
US

IV. Provider business mailing address

498 WOLCOTT LN
ORANGE CT
06477-2133
US

V. Phone/Fax

Practice location:
  • Phone: 203-500-8698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number15281
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: