Healthcare Provider Details

I. General information

NPI: 1518080175
Provider Name (Legal Business Name): LINDA DALESSIO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 WOLCOTT RD
WOLCOTT CT
06716-2641
US

IV. Provider business mailing address

246 WOLCOTT RD
WOLCOTT CT
06716-2641
US

V. Phone/Fax

Practice location:
  • Phone: 203-879-5504
  • Fax: 203-706-4233
Mailing address:
  • Phone: 203-879-5504
  • Fax: 203-879-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number003402
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003402
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: