Healthcare Provider Details

I. General information

NPI: 1750672077
Provider Name (Legal Business Name): AMY ANN LAMACCHIA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

151 FIVE FIELDS RD
MADISON CT
06443-2532
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3538
  • Fax:
Mailing address:
  • Phone: 203-779-9641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4664
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: