Healthcare Provider Details

I. General information

NPI: 1124484357
Provider Name (Legal Business Name): MELANIE M.F. NESPRIDO APRN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WESTWOOD AVE STE 100
WATERBURY CT
06708-2460
US

IV. Provider business mailing address

60 WESTWOOD AVE STE 100
WATERBURY CT
06708-2460
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-1425
  • Fax: 203-573-8236
Mailing address:
  • Phone: 203-573-1425
  • Fax: 203-573-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6416
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: