Healthcare Provider Details

I. General information

NPI: 1992807937
Provider Name (Legal Business Name): NILDA M LEON-SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 GRAND AVE FAIR HAVEN COMMUNITY HEALTH CTR
NEW HAVEN CT
06513
US

IV. Provider business mailing address

93 AUTUMN RIDGE
TRUMBALL CT
06611
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7411
  • Fax: 203-777-8506
Mailing address:
  • Phone: 203-445-1077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number035885
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: