Provider Demographics
NPI:1851670913
Name:DILORETO, MELISSA R (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:DILORETO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 WILLIARD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06457-6602
Mailing Address - Country:US
Mailing Address - Phone:860-666-5111
Mailing Address - Fax:
Practice Address - Street 1:375 WILLIARD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06457-6602
Practice Address - Country:US
Practice Address - Phone:860-666-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4712363LA2200X
CT004712363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health