MEDICARE: LINDA MARIE SCILLIA PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	16690	CT

General Provider Information

NPI Number	:	1073469672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA MARIE SCILLIA PMHNP

Provider Business Mailing Address
First Line	:	300 HEBRON AVE STE 203
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2192
Country	:	US
Telephone Number	:	860-946-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 HEBRON AVE STE 203
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2192
Country	:	US
Telephone Number	:	860-946-0447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	04/17/2026

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