Healthcare Provider Details

I. General information

NPI: 1497698914
Provider Name (Legal Business Name): JENNIFER CALDERON BAHARIAN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CRANBURY RD
NORWALK CT
06851-2617
US

IV. Provider business mailing address

75 CRANBURY RD
NORWALK CT
06851-2617
US

V. Phone/Fax

Practice location:
  • Phone: 203-505-2313
  • Fax:
Mailing address:
  • Phone: 203-505-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17408
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: