Healthcare Provider Details

I. General information

NPI: 1275359366
Provider Name (Legal Business Name): RAVSHANDZHON NAZHMIDDINOV APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2024
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CELLINI PL STE 102
WEST HAVEN CT
06516-1666
US

IV. Provider business mailing address

60 CURRIER WAY
CHESHIRE CT
06410-1432
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-6481
  • Fax: 203-932-4051
Mailing address:
  • Phone: 203-544-3521
  • Fax: 203-544-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14258
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: