Provider Demographics
NPI:1487190278
Name:DESYR, ISELANDE (DNP PMHNP-BC FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ISELANDE
Middle Name:
Last Name:DESYR
Suffix:
Gender:F
Credentials:DNP PMHNP-BC FNP-BC
Other - Prefix:DR
Other - First Name:ISELANDE
Other - Middle Name:
Other - Last Name:DESYR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP APRN PMHNP-BC
Mailing Address - Street 1:2875 MAIN ST
Mailing Address - Street 2:STE 2A
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4979
Mailing Address - Country:US
Mailing Address - Phone:929-447-2053
Mailing Address - Fax:
Practice Address - Street 1:2875 MAIN STREET
Practice Address - Street 2:SUITE 2A
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4979
Practice Address - Country:US
Practice Address - Phone:929-447-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6914363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6914Medicaid