Healthcare Provider Details

I. General information

NPI: 1336664598
Provider Name (Legal Business Name): ANTHONY MICHAEL TREZZA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 OLD TAVERN RD STE 120
ORANGE CT
06477-3464
US

IV. Provider business mailing address

3 ARMSTRONG RD # 1026
SHELTON CT
06484-4706
US

V. Phone/Fax

Practice location:
  • Phone: 203-666-2002
  • Fax: 203-202-3760
Mailing address:
  • Phone: 203-666-2002
  • Fax: 203-202-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.007151
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: