Healthcare Provider Details

I. General information

NPI: 1962238709
Provider Name (Legal Business Name): DEON S MILARDO APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 TOWN LINE RD
WETHERSFIELD CT
06109-4316
US

IV. Provider business mailing address

27 TOWN LINE RD
WETHERSFIELD CT
06109-4316
US

V. Phone/Fax

Practice location:
  • Phone: 860-894-9059
  • Fax:
Mailing address:
  • Phone: 860-894-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13889
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: