Provider Demographics
NPI:1306475306
Name:ADVANCED TELEMEDICINE LLC
Entity type:Organization
Organization Name:ADVANCED TELEMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:860-483-1074
Mailing Address - Street 1:17 MAYFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4518
Mailing Address - Country:US
Mailing Address - Phone:800-835-9812
Mailing Address - Fax:
Practice Address - Street 1:6 W RIVER ST UNIT 491
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-9471
Practice Address - Country:US
Practice Address - Phone:800-835-9812
Practice Address - Fax:888-978-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty