Basic Information
| Provider Information | |||||||||
| NPI: | 1780016881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CACCIABAUDO | ||||||||
| FirstName: | CARA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 YORK STREET, CB-2041 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036884748 | ||||||||
| FaxNumber: | 2036884740 | ||||||||
| Practice Location | |||||||||
| Address1: | 139 TODDY HILL RD | ||||||||
| Address2: | |||||||||
| City: | SANDY HOOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064821362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457975390 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2013 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 005416 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 5416 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.