Active NPI
Daniel Chick Fombo, MSN APN
- Family Nurse Practitioner
- Danbury, CT
National Provider Identifier
1730348442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 6100
- Practice address
- 67 Sand Pit Rd
Ste. 308
Danbury, CT 06810-4032 - Phone
- (203) 743-7264
- NPI assigned
- Jun 6, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 6100 | CT | Primary |
Addresses
Primary practice location
67 Sand Pit Rd
Ste. 308
Danbury, CT 06810-4032
Mailing address
67 Sand Pit Rd
Ste. 308
Danbury, CT 06810-4032
Phone (203) 743-7264
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6100 | CT | MD | Physical Rehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458172800000",
"number": "1730348442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67 SAND PIT RD",
"address_2": "STE. 308",
"city": "DANBURY",
"state": "CT",
"postal_code": "068104032",
"telephone_number": "203-743-7264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 SAND PIT RD",
"address_2": "STE. 308",
"city": "DANBURY",
"state": "CT",
"postal_code": "068104032",
"telephone_number": "203-743-7264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOMBO",
"first_name": "DANIEL",
"middle_name": "CHICK",
"name_prefix": "Mr.",
"credential": "MSN APN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-06",
"last_updated": "2016-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CT",
"license": "6100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.