Provider Demographics
NPI:1952527087
Name:DZIEDZIC, MELISSA M (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:DZIEDZIC
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 1:230 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2225
Mailing Address - Country:US
Mailing Address - Phone:203-245-0496
Mailing Address - Fax:203-245-8697
Practice Address - Street 1:230 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2225
Practice Address - Country:US
Practice Address - Phone:203-245-0496
Practice Address - Fax:203-245-8697
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001511363L00000X, 363LP0200X
CTE46742363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics