Healthcare Provider Details

I. General information

NPI: 1033049796
Provider Name (Legal Business Name): SAMANTHA JADE MOFFETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CAMPUS DR
ORANGE CT
06477-3646
US

IV. Provider business mailing address

3 OSBORNE AVE
WEST HAVEN CT
06516-7237
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-2357
  • Fax:
Mailing address:
  • Phone: 203-848-4684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number225504
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: