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General NPI Number Information
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NPI Number | 1255966222
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Entity Type | Organization
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Legal Business Name | MEDICA TODAY LLC
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 555 HIGHLAND AVE STE 23
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City | CHESHIRE
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State | CT
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Zip | 06410-2255
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Country | US
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Telephone | 203-816-5551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 921
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City | WALLINGFORD
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State | CT
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Zip | 06492-0921
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Country | US
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Telephone | 203-816-5551
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Fax | 203-816-5551
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Authorized Official
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Title or Position | NP-C
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Name | DR. CHANON C BICEGLIA
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Credential | DNP
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Telephone | 203-816-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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