Provider Demographics
NPI:1407416175
Name:FONTANELLA, STEPHANIE MELISSA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MELISSA
Last Name:FONTANELLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:MELISSA
Other - Last Name:MULKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:428 HARTFORD TPKE STE 207
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:428 HARTFORD TPKE STE 207
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4841
Practice Address - Country:US
Practice Address - Phone:860-872-5426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2324164363L00000X
CT112872363L00000X
CT8324363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner