=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053706499
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNA SMALDONE DNP/FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2015
-----------------------------------------------------
Last Update Date | 04/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46 ALBION STREET
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-330-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 LEWIS ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460-6333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-534-4895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family
-----------------------------------------------------
License Number | 006076
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------