Healthcare Provider Details

I. General information

NPI: 1790410322
Provider Name (Legal Business Name): MICHELLE MARIE CUNHA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHESTNUT HILL RD
STAFFORD SPRINGS CT
06076-4005
US

IV. Provider business mailing address

43 BROOK RD
ENFIELD CT
06082-2710
US

V. Phone/Fax

Practice location:
  • Phone: 860-684-8111
  • Fax:
Mailing address:
  • Phone: 860-305-2914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number135606
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: