Suffield Pediatric and Adolescent Medicine PLLC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

Legal business name

SUFFIELD PEDIATRIC AND ADOLESCENT MEDICINE PLLC

Practice address

230C Mountain Rd
Suffield, CT 06078-3019

Phone

(860) 836-5416

NPI assigned

Aug 25, 2023

Last updated

Aug 25, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Melissa J Lee, APRNNPI 1194378539

Title

Owner

Phone

(860) 836-5416

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Melissa Jenkins Lee

  • Pediatric Nurse Practitioner
  • Hartford, CT
  • NPI 1194378539

  Pediatrics

  Medicare reassignment NPD Authorized official
• Rebecca L Brady, APRN

  • Pediatric Nurse Practitioner
  • West Suffield, CT
  • NPI 1659609584

  Pediatrics

  Medicare reassignment NPD

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

{
    "created_epoch": "1692921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1841075264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 BROOKSIDE DR",
            "city": "SUFFIELD",
            "state": "CT",
            "postal_code": "060781530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230C MOUNTAIN RD",
            "city": "SUFFIELD",
            "state": "CT",
            "postal_code": "060783019",
            "telephone_number": "860-836-5416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUFFIELD PEDIATRIC AND ADOLESCENT MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-25",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-836-5416",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suffield by the River, LLC
• Suffield Eye Care
• Suffield Eye Care, PLLC
• Suffield Manor Inc (The Suffield House)
• Suffield Medical Associates PLLC
• Suffield Psychology Associates
• Suffield SNF Operations LLC
• Suffield Village Dental
• Suffield Volunteer Ambulance Association Inc
• Mark Allen Sullivan, MBA, PT, ATC

• Pediatric Nurse Practitioner in Suffield, CT
• Providers in Suffield, 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 Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.