Healthcare Provider Details

I. General information

NPI: 1275989832
Provider Name (Legal Business Name): LISA RAMONDETTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CORPORATE DR FL 9
SHELTON CT
06484-6238
US

IV. Provider business mailing address

99 E RIVER DR FL 5
EAST HARTFORD CT
06108-7301
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-7353
  • Fax: 203-929-0756
Mailing address:
  • Phone: 860-282-4104
  • Fax: 860-282-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number109892
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9147
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: