Healthcare Provider Details

I. General information

NPI: 1487282216
Provider Name (Legal Business Name): NICOLE CATHERINE EPISALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

330 CEDAR ST
NEW HAVEN CT
06510-3218
US

V. Phone/Fax

Practice location:
  • Phone: 203-432-4771
  • Fax:
Mailing address:
  • Phone: 203-432-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number1.085412
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: