Healthcare Provider Details

I. General information

NPI: 1114835881
Provider Name (Legal Business Name): LIZZIE PITTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RESEARCH DR
SHELTON CT
06484-6280
US

IV. Provider business mailing address

47 HURD AVE
MONROE CT
06468-2305
US

V. Phone/Fax

Practice location:
  • Phone: 203-400-5211
  • Fax:
Mailing address:
  • Phone: 203-449-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193829
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: