Healthcare Provider Details

I. General information

NPI: 1710791017
Provider Name (Legal Business Name): AMBER CHRISTINE HENRIQUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER CHRISTINE LAPTIK APRN

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 BRIDGEPORT AVE STE A
SHELTON CT
06484-7901
US

IV. Provider business mailing address

795 BRIDGEPORT AVE STE A
SHELTON CT
06484-7901
US

V. Phone/Fax

Practice location:
  • Phone: 860-650-3848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14448
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: