Healthcare Provider Details

I. General information

NPI: 1639116957
Provider Name (Legal Business Name): RICHARD FRANK COMSHAW II PHD APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 SILAS DEANE HWY
ROCKY HILL CT
06067-2329
US

IV. Provider business mailing address

238 CONGDON ST E
MIDDLETOWN CT
06457-2063
US

V. Phone/Fax

Practice location:
  • Phone: 860-996-1569
  • Fax:
Mailing address:
  • Phone: 860-736-4139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberE55764
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number001702
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: