MEDICARE: DR. AMY A PAYSON EDD CS APRN BC

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	000869	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	173546	OTHER	CT	HEALTH NET
3	400000869CT01	OTHER	CT	CT ANTHEM BLUE CROSS BLUE
4	122025	OTHER	CT	VALUE OPTIONS

General Provider Information

NPI Number	:	1205982030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY A PAYSON EDD CS APRN BC

Provider Business Mailing Address
First Line	:	16 OLD DAIRY RD
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-4954
Country	:	US
Telephone Number	:	203-394-2423
Fax Number	:	203-375-5619

Provider Business Practice Location Address
First Line	:	2335 BLACK ROCK TPKE
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-3220
Country	:	US
Telephone Number	:	203-373-1234
Fax Number	:	203-375-5619

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	12/01/2013

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