Michelle A Mattiaccio, APRN BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

003538 Issued in CT

Practice address

88 Grandview Ave
Waterbury, CT 06708-2509

Phone

(203) 573-7500

Fax

(203) 573-6575

NPI assigned

Nov 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Waterbury Hospital

  • General Acute Care Hospital
  • Waterbury, CT
  • NPI 1184615114
  NPD (past)

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1386710176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MIDLAND RD",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067053412",
            "telephone_number": "203-755-8874",
            "fax_number": "203-597-9570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 GRANDVIEW AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082509",
            "telephone_number": "203-573-7500",
            "fax_number": "203-573-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTIACCIO",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "APRN BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "003538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ken Matsuo, MD
• Mattatuck Dentistry & Implants
• Mattatuck Health Care Facility, Inc.
• Christine Marie Matthews, LPC ASSOCIATE
• Lynn Anne Matthews, OTR/L
• Katie Mattson, INTERNSHIP
• David Robert Matusz, L.O.
• Richard Matza, M.D.
• Michael C Matzkin, DDS
• Berthny Maurice

• Adult Health Nurse Practitioner in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Adult Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.