Provider Demographics
NPI:1831443001
Name:SAVARIA, MARY ANN MELISSA (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:MELISSA
Last Name:SAVARIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MARY ANN
Other - Middle Name:MELISSA
Other - Last Name:SHONYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-0006
Mailing Address - Country:US
Mailing Address - Phone:860-455-6410
Mailing Address - Fax:800-208-7705
Practice Address - Street 1:111 WESTCOTT RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2929
Practice Address - Country:US
Practice Address - Phone:860-455-6410
Practice Address - Fax:800-208-7705
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5217363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health