Diane E Fahey, APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

000373 Issued in CT

Practice address

755 Campbell Ave
Suite 2
West Haven, CT 06516-3715

Phone

(203) 889-2297

Fax

(203) 889-2249

NPI assigned

Dec 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Advanced Care of West Haven LLC

  • Pediatric Nurse Practitioner
  • West Haven, CT
  • NPI 1942669916

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1144385261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 CAMPBELL AVE",
            "address_2": "SUITE 2",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065163715",
            "telephone_number": "203-889-2297",
            "fax_number": "203-889-2249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 CAMPBELL AVE",
            "address_2": "SUITE 2",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065163715",
            "telephone_number": "203-889-2297",
            "fax_number": "203-889-2249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHEY",
        "first_name": "DIANE",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "000373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001177757",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "000373",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy Scott Evans, APRN
• Tarin Evans
• Deborah Everhart, PH.D.
• Shelly Rose Evia, PHARMD
• Extended Family Homemaker and Companion LLC
• Brittany Faison, RN
• Bridgette Falco, PHARMD.
• Kristy Daub Falco, PHARM.D.
• Nicholas J Falco, PHARM.D.
• Margaret Falkowski, LCSW

• Pediatric Nurse Practitioner in West Haven, CT
• Providers in West Haven, CT by specialty
• Pediatric Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.