Fazzolari, Melissa A

Fazzolari, Melissa A is an individual health care provider with primary practice located at 850 N Main Street Ext Ste B , Wallingford CT 06492. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Gerontology is her primary health care specialty. Fazzolari, Melissa A can be contacted via phone (203) 886-0036.

Contact Information

Primary practice address
850 N Main Street Ext Ste B Wallingford CT 06492
Phone: (203) 886-0036
Fax: (203) 886-0072
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 7770 Connecticut
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 7770 Connecticut

Profile Details

NPI number 1477041564
LBN Legal business name Fazzolari, Melissa A
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2018
Last updated Aug 30th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477041564 NPPES
Connecticut MEDICAID 008082360

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