Basic Information
| Provider Information | |||||||||
| NPI: | 1881848117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDES | ||||||||
| FirstName: | RODRIGO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 TRAP FALLS ROAD | ||||||||
| Address2: | SUITE 414 | ||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064847623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039297353 | ||||||||
| FaxNumber: | 2039299190 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 TRAP FALLS ROAD | ||||||||
| Address2: | SUITE 414 | ||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039297353 | ||||||||
| FaxNumber: | 2039299190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2008 | ||||||||
| LastUpdateDate: | 06/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 071769 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.