Provider Demographics
NPI:1558087072
Name:BENEDETTO, MELISSA CARRIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CARRIE
Last Name:BENEDETTO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1844
Mailing Address - Country:US
Mailing Address - Phone:914-414-9019
Mailing Address - Fax:
Practice Address - Street 1:NEW FAIRFIELD FAMILY PRACTICE
Practice Address - Street 2:130 CT-37
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812
Practice Address - Country:US
Practice Address - Phone:203-746-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11084OtherLICENSE