Provider Demographics
NPI:1750355772
Name:WILDSTEIN, HEIDI BRYNA (APRN MSN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:BRYNA
Last Name:WILDSTEIN
Suffix:
Gender:F
Credentials:APRN MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9805
Mailing Address - Street 2:300 GEORGE ST, 6TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06536-0805
Mailing Address - Country:US
Mailing Address - Phone:203-785-7998
Mailing Address - Fax:203-785-6414
Practice Address - Street 1:422 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2526
Practice Address - Country:US
Practice Address - Phone:203-304-4961
Practice Address - Fax:203-306-2905
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002442363LP0200X
CT2442364SP0807X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004218740Medicaid
CT004218740Medicaid
CT500000723Medicare ID - Type Unspecified