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NPI Code Detail

MEDICARE: JUSTIN MATTHEW PEDNEAULT BSN, RN, CFRN, FP-C

MEDICARE: JUSTIN MATTHEW PEDNEAULT BSN, RN, CFRN, FP-C
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
1146L00000XParamedic4079CT
2163WF0300XFlight Registered Nurse161494CT
3163WC0200XCritical Care Medicine Registered Nurse161494CT

General Provider Information

NPI Number : 1215883608
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN MATTHEW PEDNEAULT BSN, RN, CFRN, FP-C
Provider Business Mailing Address
First Line : 80 SEYMOUR ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3315
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 80 SEYMOUR ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3315
Country : US
Telephone Number : 860-545-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2026
Last Update Date : 03/09/2026

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