Provider Demographics
NPI:1689385767
Name:MASSARO, REIA (APRN)
Entity type:Individual
Prefix:
First Name:REIA
Middle Name:
Last Name:MASSARO
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 1:2200 WHITNEY AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3695
Mailing Address - Country:US
Mailing Address - Phone:203-903-8308
Mailing Address - Fax:
Practice Address - Street 1:2200 WHITNEY AVE STE 290
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3695
Practice Address - Country:US
Practice Address - Phone:203-903-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.011322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily