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General NPI Number Information
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NPI Number | 1407422934
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Entity Type | Organization
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Legal Business Name | APPLESEED PEDIATRIC AND ADOLESCENT MEDICINE
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 80 E MAIN ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3840
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Country | US
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Telephone | 860-200-1465
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Fax | 860-200-3378
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Provider Business Mailing Address
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Address Line | 80 E MAIN ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3840
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Country | US
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Telephone | 860-200-1465
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Fax | 860-200-3378
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLE LYNN KYCIA
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Credential | PA-C
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Telephone | 860-558-3177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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