Provider Demographics
NPI:1881478576
Name:AMAECHI, ALFRED
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:AMAECHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BROOKLAWN TER
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1708
Mailing Address - Country:US
Mailing Address - Phone:203-543-7059
Mailing Address - Fax:
Practice Address - Street 1:38 TALMADGE AVE
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-3541
Practice Address - Country:US
Practice Address - Phone:203-469-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT163179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse