Healthcare Provider Details

I. General information

NPI: 1386557437
Provider Name (Legal Business Name): COREY LEITE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 MAIN ST
STRATFORD CT
06614-1393
US

IV. Provider business mailing address

46 SOUNDVIEW AVE
MILFORD CT
06460-7877
US

V. Phone/Fax

Practice location:
  • Phone: 203-583-9301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number18420
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: