Provider Demographics
NPI:1518513647
Name:CANTIELLO, DANA MARIE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:CANTIELLO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
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Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 SAYBROOK RD STE 210
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4700
Practice Address - Country:US
Practice Address - Phone:860-358-2970
Practice Address - Fax:860-347-1630
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT12363L00000X
CT8419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner