Healthcare Provider Details

I. General information

NPI: 1881848117
Provider Name (Legal Business Name): RODRIGO MENDES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRAP FALLS ROAD SUITE 414
SHELTON CT
06484
US

IV. Provider business mailing address

2 TRAP FALLS ROAD SUITE 414
SHELTON CT
06484-7623
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-7353
  • Fax: 203-929-9190
Mailing address:
  • Phone: 203-929-7353
  • Fax: 203-929-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number071769
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: