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NPI Code Detail

MEDICARE: MELISSA M DZIEDZIC APRN

MEDICARE: MELISSA M DZIEDZIC APRN
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
1363L00000XNurse Practitioner001511CT
2363L00000XNurse PractitionerE46742CT
3363LP0200XPediatric Nurse PractitionerE46742CT
4363LP0200XPediatric Nurse Practitioner001511CT

General Provider Information

NPI Number : 1952527087
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA M DZIEDZIC APRN
Provider Business Mailing Address
First Line : 230 BOSTON POST RD
Second Line :
City : MADISON
State : CT
Zip : 06443-2225
Country : US
Telephone Number : 203-245-0496
Fax Number : 203-245-8697
Provider Business Practice Location Address
First Line : 230 BOSTON POST RD
Second Line :
City : MADISON
State : CT
Zip : 06443-2225
Country : US
Telephone Number : 203-245-0496
Fax Number : 203-245-8697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 06/25/2013

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