Healthcare Provider Details

I. General information

NPI: 1942995683
Provider Name (Legal Business Name): ALEXA VELEY SAMPINO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXA ANNE VELEY CRNA

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 MAIN ST
WILLIMANTIC CT
06226-2093
US

IV. Provider business mailing address

1185 MAIN ST
WILLIMANTIC CT
06226-2093
US

V. Phone/Fax

Practice location:
  • Phone: 860-423-7558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number12.012008
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: