Basic Information
| Provider Information | |||||||||
| NPI: | 1114587193 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SPADERNA | ||||||||
| FirstName: | STEVEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 CRYSTAL RIDGE DR | ||||||||
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| City: | TOLLAND | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060842165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609160455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 GRAND ST | ||||||||
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| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060522016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602245305 | ||||||||
| FaxNumber: | 8602245740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2019 | ||||||||
| LastUpdateDate: | 04/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 12.008260 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | 8260 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.