Healthcare Provider Details

I. General information

NPI: 1154637296
Provider Name (Legal Business Name): SHINYMOL CHEMMARAPPALLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BISHOP RD
OXFORD CT
06478-1597
US

IV. Provider business mailing address

9 BISHOP RD
OXFORD CT
06478-1597
US

V. Phone/Fax

Practice location:
  • Phone: 866-881-0979
  • Fax:
Mailing address:
  • Phone: 866-881-0979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number004455
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: