Healthcare Provider Details

I. General information

NPI: 1285322776
Provider Name (Legal Business Name): MICAELA NOEL MONGELLI M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICAELA MASTROFRANCESCO

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 02/05/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PROGRESS DR STE 2B
SHELTON CT
06484-6294
US

IV. Provider business mailing address

51 WHITE ST
WATERTOWN CT
06795-1603
US

V. Phone/Fax

Practice location:
  • Phone: 475-239-5512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7280
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: