Michael Distasio
Nurse Practitioner, Family in New Haven, CT. Individual provider (NPI-1).
NPI number1194580795
StatusActive
Last updated in NPPESDec 5, 2024
Details
- NPI
- 1194580795
- Entity type
- Individual (NPI-1)
- Name
- Michael Distasio
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 14, 2024
- Certification date
- Dec 5, 2024
- Last updated
- Dec 5, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 14094 | CT | Yes |
| 163WC0200X | Registered Nurse, Critical Care Medicine | 154019 | CT |
Practice location
Yale New Haven Health789 Howard Avenue
New Haven, CT 06460
Phone 203-430-6379
Mailing address
69 Carriage Path SMilford, CT 06460-7544
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