Healthcare Provider Details

I. General information

NPI: 1073073011
Provider Name (Legal Business Name): BRANDON E NUSSENBLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BEARD SAWMILL RD STE 250
SHELTON CT
06484-6178
US

IV. Provider business mailing address

100 BEARD SAWMILL RD STE 250
SHELTON CT
06484-6178
US

V. Phone/Fax

Practice location:
  • Phone: 203-922-7870
  • Fax: 203-922-7873
Mailing address:
  • Phone: 203-922-7870
  • Fax: 203-922-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number85397
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: