STAYWELL PEDIATRIC LLC (NPI# 1255521019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255521019 |
| Entity Type | Organization |
| Organization Name | STAYWELL PEDIATRIC LLC |
| Practice Address |
365 Elm St West Haven CT 06516-4217 |
| Practice Telephone | 2039323227 |
| Practice Fax Number | 2039312847 |
| Mailing Telephone | 2039323227 |
| Mailing Fax Number | 2039312847 |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2007-07-27 |
| Authorized Official Name | DR. THOMAS ETKIN (OWNER) |
| Authorized Official Telephone | 2309323227 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
000373 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841498839 | Staywell Pediatric LLC | Pediatrics | 365 Elm St, West Haven, CT 06516-4217 | 2007-07-11 |
| Street Address |
365 ELM ST |
| City | WEST HAVEN |
| State | CT |
| Zip Code | 06516-4217 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043397557 | Simone K. Simon | Pediatrics | 365 Elm St, West Haven, CT 06516-4217 | 2006-11-01 |
| 1114167350 | Jobey Jacob | Pediatrics | 365 Elm St, West Haven, CT 06516-4217 | 2009-02-28 |
| 1841498839 | Staywell Pediatric LLC | Pediatrics | 365 Elm St, West Haven, CT 06516-4217 | 2007-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255956421 | Thomas Lorbie Thomson IIi | Nurse Practitioner | Va Connecticut Healthcare, 950 Campbell Avenue, Mail Code: 11acsl1, Building 2b, West Haven, CT 06516 | 2020-06-12 |
| 1659911238 | Claudine Pettigrew | Social Worker | 114-52 Boston Post Road, West Haven, CT 06516 | 2020-01-10 |
| 1811531544 | Medical Center Pharmacy and Home Care Center, Inc. | Pharmacy | 600 Derby Avenue, West Haven, CT 06516 | 2019-11-06 |
| 1821649203 | Michaela Lachance | Physical Therapist | 95 Campbell Ave, West Haven, CT 06516 | 2019-09-26 |
| 1295215739 | Lisa Marie Litrenta | Social Worker | 114-152 Boston Post Rd, #2, West Haven, CT 06516 | 2018-08-15 |
| 1386121895 | Theresa Boateng | Homemaker | 150 Shingle Hill Rd, West Haven, CT 06516 | 2018-07-26 |
| 1902383458 | Bianca Gondek | Social Worker | 114-152 Boston Post Rd #2, West Haven, CT 06516 | 2018-07-26 |
| 1790279172 | Blanca L. Paccha | Nurse Practitioner | 950 Campbell Ave Bldg 2b, West Haven, CT 06516 | 2018-06-19 |
| 1184133597 | Lotus Counseling Services LLC | Counselor | 101 White St, West Haven, CT 06516 | 2017-09-28 |
| 1053867283 | Alesia Wellington | Social Worker | 114-152 Boston Post Rd, 2nd Floor, West Haven, CT 06516 | 2016-08-28 |
| Find all providers in zip 06516 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033460571 | Susan Marchitto | Nurse Practitioner | 6 Cove Brook Rd, West Haven, CT 06516-4861 | 2012-09-24 |
| 1942669916 | Pediatric Advanced Care of West Haven LLC | Nurse Practitioner | 755 Campbell Ave, Suite 2, West Haven, CT 06516-3715 | 2016-02-18 |
| 1750681003 | Elizabeth Marcucio | Nurse Practitioner | 755 Campbell Ave, Suite 2, West Haven, CT 06516-3715 | 2010-11-02 |
| 1144385261 | Diane E Fahey | Nurse Practitioner | 755 Campbell Ave, Suite 2, West Haven, CT 06516-3715 | 2006-12-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447878855 | Ashley Elusma | Nurse Practitioner | 92 New London Tpke # 1, Norwich, CT 06360-2616 | 2020-07-13 |
| 1396382792 | Jessca Morcone | Nurse Practitioner | 640 Brookside Dr, Fairfield, CT 06824-2419 | 2019-12-04 |
| 1790337137 | Elizabeth R Renker | Nurse Practitioner | 97 Barnes Rd Ste 6, Wallingford, CT 06492-1885 | 2019-07-16 |
| 1508347162 | Bright Futures Wellness Center, LLC | Nurse Practitioner | 422-426 Highland Avenue, Cheshire, CT 06410 | 2018-08-22 |
| 1487180840 | Meghan Mccarthy Warzoha | Nurse Practitioner | 2001 W Main St Ste 132, Stamford, CT 06902-4544 | 2017-05-04 |
| 1891179537 | Heather Deal | Nurse Practitioner | 347 Hartford Turnpike, Vernon, CT 06066 | 2015-07-13 |
| 1083020051 | Douglas Mccoy | Nurse Practitioner | 46 Albion St., Bridgeport, CT 06605 | 2014-07-10 |
| 1740602515 | Smart Start Pediatrics | Nurse Practitioner | 27 Sycamore St., Suite 300, Glastonbury, CT 06033 | 2014-01-14 |
| 1780013102 | Elizabeth Anavy | Nurse Practitioner | 195 Hillandale Ave, Stamford, CT 06902-2823 | 2013-11-06 |
| 1174951669 | Bela Kirit Dharia | Nurse Practitioner | 55 Lock Street, Yale Health, New Haven, CT 06511-3603 | 2013-10-22 |
| Find all providers with the same taxonomy | ||||
| City | WEST HAVEN |
| Zip Code | 06516 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.