Healthcare Provider Details

I. General information

NPI: 1104115989
Provider Name (Legal Business Name): LARISA A. FLEYSHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850-3815
US

IV. Provider business mailing address

5520 PARK AVE
TRUMBULL CT
06611-3463
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2204
  • Fax: 203-852-3109
Mailing address:
  • Phone: 203-502-8400
  • Fax: 203-502-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4583
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: