Healthcare Provider Details

I. General information

NPI: 1427945641
Provider Name (Legal Business Name): DERMATOLOGY PARTNERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N MAIN STREET EXT STE 2A2
WALLINGFORD CT
06492-2483
US

IV. Provider business mailing address

850 N MAIN STREET EXT STE 2A2
WALLINGFORD CT
06492-2483
US

V. Phone/Fax

Practice location:
  • Phone: 203-626-5581
  • Fax:
Mailing address:
  • Phone: 203-626-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROSA BRUNELLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 203-626-5581