Healthcare Provider Details

I. General information

NPI: 1992129886
Provider Name (Legal Business Name): ALICIA COLLEN ZEIDAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MOTT AVE STE 2A
NORWALK CT
06850
US

IV. Provider business mailing address

10 MOTT AVE STE 2A
NORWALK CT
06850-3320
US

V. Phone/Fax

Practice location:
  • Phone: 203-899-1770
  • Fax: 203-852-3989
Mailing address:
  • Phone: 203-899-1770
  • Fax: 203-852-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5715
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: