Provider Demographics
NPI:1528008489
Name:DESHPANDE, JUDITH ANN (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 BOSTON POST RD
Mailing Address - Street 2:ATTN: HEALTH SERVICES
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1916
Mailing Address - Country:US
Mailing Address - Phone:203-932-7079
Mailing Address - Fax:203-931-6090
Practice Address - Street 1:300 BOSTON POST RD
Practice Address - Street 2:ATTN: HEALTH SERVICES
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1916
Practice Address - Country:US
Practice Address - Phone:203-932-7079
Practice Address - Fax:203-931-6090
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004251857Medicaid
CT223514271OtherUNITED HEALTHCARE
CT2V4674OtherHEALTHNET
CT020853OtherCONNECTICARE
CTA752119OtherOXFORD
CT400002853CT01OtherBLUE CROSS BLUE SHIELD
CT400002853CT01OtherBLUE CROSS BLUE SHIELD
CT500001477Medicare Oscar/Certification