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General NPI Number Information
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NPI Number | 1790659977
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Entity Type | Individual
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Provider Name | STEPHANIE GESUALDI
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Gender | Female
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 4697 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-1869
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Country | US
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Telephone | 203-366-0664
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Fax |
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Provider Business Mailing Address
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Address Line | 35 BARNEY ST
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City | RUMFORD
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State | RI
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Zip | 02916-1201
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Country | US
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Telephone | 203-710-2304
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 15482
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License Number State | CT
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