Kelly M Bucci-didomenico, | |
479 Helen St, Bridgeport, CT 06608-1321 | |
(203) 579-8310 | |
(203) 683-3620 |
Full Name | Kelly M Bucci-didomenico |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 479 Helen St, Bridgeport, Connecticut |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1568795094 | NPI | - | NPPES |
004234788 | Medicaid | CT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 1809 (Connecticut) | Primary |
Entity Name | Optimus Health Care Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1669445946 PECOS PAC ID: 9335051580 Enrollment ID: O20031105000254 |
Mailing Address | Practice Location Address |
---|---|
Kelly M Bucci-didomenico, 471 Barnum Ave, Bridgeport, CT 06608-2409 Ph: (203) 576-3885 | Kelly M Bucci-didomenico, 479 Helen St, Bridgeport, CT 06608-1321 Ph: (203) 579-8310 |
Ryan Keenan, PMHNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 267 Grant St, Bridgeport, CT 06610 Phone: 203-384-3000 | |
Caroline Mead Farrell, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 725 Park Ave, Bridgeport, CT 06604 Phone: 908-489-4847 | |
Miss Sandra Shipkowitz, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 267 Grant St, Bridgeport, CT 06610 Phone: 203-384-4490 | |
Patricia Anne Simpson, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 267 Grant St, Bridgeport, CT 06610 Phone: 203-368-3000 | |
Dr. Samantha Mraz, DNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 46 Albion St, Bridgeport, CT 06605 Phone: 203-332-3584 | |
Esther M Mervil, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 471 Barnum Ave, Bridgeport, CT 06608 Phone: 203-333-6864 Fax: 203-332-0376 | |
Asena Derohannesian, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 425 Thorme St, Bridgeport, CT 06606 Phone: 203-275-4115 Fax: 203-275-0198 |