MEDICARE: MICHAEL ROBERT ESPELIN APRN, 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	7939	CT

General Provider Information

NPI Number	:	1790253995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROBERT ESPELIN APRN, PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 321
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-0321
Country	:	US
Telephone Number	:	203-745-2368
Fax Number	:	928-272-0190

Provider Business Practice Location Address
First Line	:	145 DURHAM RD STE 6
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2656
Country	:	US
Telephone Number	:	203-745-2368
Fax Number	:	928-272-0190

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

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	04/24/2026

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