Healthcare Provider Details

I. General information

NPI: 1891614715
Provider Name (Legal Business Name): ENIKO MAGDOLNA SZEDLACSEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 NORTHVIEW DR
SOUTH WINDSOR CT
06074-3517
US

IV. Provider business mailing address

72 NORTHVIEW DR
SOUTH WINDSOR CT
06074-3517
US

V. Phone/Fax

Practice location:
  • Phone: 860-938-1818
  • Fax:
Mailing address:
  • Phone: 860-938-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17474
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: