DAEDLY POTUSEK (NPI# 1578022166) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578022166 |
| Entity Type | Individual |
| Full Name | DAEDLY POTUSEK |
| Practice Address |
80 Phoenix Ave Waterbury CT 06702-1418 |
| Practice Telephone | 2037568021 |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2019-03-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
8133 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
80 PHOENIX AVE |
| City | WATERBURY |
| State | CT |
| Zip Code | 06702-1418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497756902 | Michael Bass | Dentist | 80 Phoenix Ave, Suite #102, Waterbury, CT 06702-1418 | 2005-08-09 |
| 1356996920 | Raeven B Keene | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2019-08-09 |
| 1598239873 | Ashley Corso | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2019-01-19 |
| 1326510801 | Monica Rose Depaolo | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2018-12-21 |
| 1023536232 | Courtney Dowen | Nurse Practitioner | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2017-09-07 |
| 1851834147 | Lindsey Maloney | Nurse Practitioner | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2016-11-18 |
| 1063864346 | Miguel Mantilla | Internal Medicine | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2016-07-11 |
| 1124477518 | George Gogas | Social Worker | 80 Phoenix Ave, Suite 201, Waterbury, CT 06702-1418 | 2016-06-07 |
| 1649626300 | Irene Maturo | Dental Hygienist | 80 Phoenix Ave, Suite 201, Waterbury, CT 06702-1418 | 2016-05-11 |
| 1821465170 | Josseelaine Diaz | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2015-08-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780120295 | Melitza Velez | Counselor | 80 Prospect St., Waterbury, CT 06702 | 2017-01-09 |
| 1467813600 | Ashley Joseph | Counselor | 30 Holmes Ave, Waterbury, CT 06702 | 2016-03-16 |
| 1649662313 | Lori Arens | Social Worker | 141 E Main St Fl 4, Waterbury, CT 06702 | 2015-03-04 |
| 1265725584 | Zelda Shleifer | Audiologist | 21 W Main St Fl Place-3, Waterbury, CT 06702 | 2011-05-19 |
| 1700024585 | Charlene Angela Jurgaitis | Durable Medical Equipment & Medical Supplies | 102 Grand Street, Waterbury, CT 06702 | 2009-02-02 |
| 1518090570 | Nathan Z Imre | Pharmacist | 161 East Main St Central Pharmacy, Waterbury, CT 06702 | 2007-03-13 |
| 1922149467 | Rachael A Petitti | Social Worker | 402 East Main Street, Waterbury, CT 06702 | 2007-02-09 |
| 1710024484 | Abbot Terrace Health Center | Assisted Living Facility | 44 Abbott Terrace, Waterbury, CT 06702 | 2007-01-31 |
| 1205994555 | Michael Arcangel Padilla | Social Worker | Western Connecticut Mental Health Network, 55 West Main Street Suite 410, Waterbury, CT 06702 | 2006-12-05 |
| 1205902723 | Colette M Anderson | Social Worker | 55 West Main St Suite 410, Western Connecticut Mental Health Network, Waterbury, CT 06702 | 2006-11-27 |
| Find all providers in zip 06702 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467072033 | Sarah Michelle Whalen | Nurse Practitioner | 100 Jefferson Sq, Waterbury, CT 06706-1109 | 2020-04-23 |
| 1720616246 | Susan Antoinette Pappas | Nurse Practitioner | 88 Grandview Ave, Waterbury, CT 06708-2509 | 2020-03-30 |
| 1124592274 | Deon Johnson-allen | Nurse Practitioner | 88 Grandview Ave, Waterbury, CT 06708-2509 | 2019-01-11 |
| 1356818421 | Olanike Oyeyemi Idowu | Nurse Practitioner | 64 Robbins St, Waterbury, CT 06708-2613 | 2018-10-26 |
| 1104344506 | Kimberly Burns | Nurse Practitioner | 30 Holmes Ave, Waterbury, CT 06710-2412 | 2017-09-06 |
| 1114462561 | Shantelle Brokaw | Nurse Practitioner | 128 Cedar Ave, Waterbury, CT 06705-2700 | 2016-12-21 |
| 1407201957 | Alexandria Smith | Nurse Practitioner | 30 Holmes Ave, Waterbury, CT 06710-2412 | 2016-05-03 |
| 1134504715 | Nicholas James O'brien | Nurse Practitioner | 60 N Main St, 3rd Floor, Waterbury, CT 06702-1443 | 2015-07-24 |
| 1225461221 | Alyson Nicolosi | Nurse Practitioner | 80 Phoenix Ave, Suite 201, Waterbury, CT 06702-1418 | 2013-08-13 |
| 1780997601 | Barbara Kimble-goodman | Nurse Practitioner | 95 Thomaston Ave, Waterbury, CT 06702-1007 | 2010-07-20 |
| Find all providers in WATERBURY | ||||
Please comment or provide details below to improve the information on DAEDLY POTUSEK.
| 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.