Healthcare Provider Details

I. General information

NPI: 1932903812
Provider Name (Legal Business Name): DEBRA SKUDZIENSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR UNIT C302
TRUMBULL CT
06611-6347
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC-CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 203-445-7093
  • Fax: 203-638-7991
Mailing address:
  • Phone: 860-972-5507
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14262
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: