Provider Demographics
NPI:1609967496
Name:BREGANTE, AUDREY C (APRN RN NP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:C
Last Name:BREGANTE
Suffix:
Gender:F
Credentials:APRN RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 EAST AVENUE
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-838-4034
Mailing Address - Fax:203-853-6361
Practice Address - Street 1:148 EAST AVENUE
Practice Address - Street 2:SUITE 3G
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-838-4034
Practice Address - Fax:203-853-6361
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002826207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01948094Medicaid
CT500001849Medicare PIN