Unknown Individual – Family Nurse Practitioner, NPI 1356453435

Unknown Individual is a healthcare provider. based in Trumbull, Connecticut. specializing in Family Nurse Practitioner. They hold a License No. 002525 (CT). The NPI Number for Unknown Individual is 1356453435

Main info

Organization
Inactive
25 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1356453435
Phone
(203) 372-4065
Address
112 QUARRY RD
Deactivation Date
28 January 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2032256020
Graduation Year
2001 (25 years ago)
PAC ID
5698839298
Group Practice PAC ID
1254233836
Professional Enrollment ID
I20090127000182
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 112, Quarry Road, Avalon Gates, Trumbull, Fairfield County, Connecticut, 06611, United States

    SUITE 120

    TRUMBULL, CT 066114816

    Phone: (203) 372-4065

    Fax: (203) 372-1644

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 06611)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1254233836View full group profile
NameSpecialtyState
Interventional Cardiology, Cardiovascular Disease (Cardiology)CT
-CT
-CT
Internal MedicineNJ
Hospitalist, Internal MedicineCT
-CT
-CT
Internal MedicineCT
Nurse PractitionerCT
Physician AssistantCT

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1356453435.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Family Nurse Practitioner in the taxonomy section. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Trumbull, Connecticut?
If you are local to Trumbull, Connecticut, Unknown Individual may be relevant to your search.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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