Provider Demographics
NPI:1225484314
Name:MUNIZ, CARLY MELISSA
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:MELISSA
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URGENT CARE 447 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108
Mailing Address - Country:US
Mailing Address - Phone:137-269-5754
Mailing Address - Fax:949-695-4310
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5675
Practice Address - Fax:860-224-5774
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3608363A00000X
MAPA6279363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant