Provider Demographics
NPI:1699461624
Name:DAPONTE, CHRISTY
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:DAPONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01535-2003
Mailing Address - Country:US
Mailing Address - Phone:508-414-5822
Mailing Address - Fax:
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:860-972-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6166363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical