Healthcare Provider Details

I. General information

NPI: 1598462004
Provider Name (Legal Business Name): ADRIENNE MENEO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 DAY ST
NORWALK CT
06854-4901
US

IV. Provider business mailing address

635 MAIN ST
MIDDLETOWN CT
06457-2718
US

V. Phone/Fax

Practice location:
  • Phone: 203-854-9292
  • Fax:
Mailing address:
  • Phone: 860-347-6971
  • Fax: 860-638-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number008902
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: