Provider Demographics
NPI:1760935373
Name:DIMAURO, MICHELLE C (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:DIMAURO
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 1:107 NEWTOWN RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4180
Mailing Address - Country:US
Mailing Address - Phone:203-830-4700
Mailing Address - Fax:203-730-4166
Practice Address - Street 1:107 NEWTOWN RD STE 1B
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4151
Practice Address - Country:US
Practice Address - Phone:203-830-4700
Practice Address - Fax:203-790-5324
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6574363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner