Provider Demographics
NPI:1790579027
Name:BRAKONIECKI, NATALIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:BRAKONIECKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 GOVERNOR TRUMBULL WAY
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5605
Mailing Address - Country:US
Mailing Address - Phone:203-223-3515
Mailing Address - Fax:
Practice Address - Street 1:133 GOVERNOR TRUMBULL WAY
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5605
Practice Address - Country:US
Practice Address - Phone:203-223-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health