| Stony Creek Wellness Group, Llc | |
|
2415 Boston Post Rd Unit 12 Guilford CT 06437-4348 | |
| (203) 693-4566 | |
| (203) 457-5970 |
| Full Name | Stony Creek Wellness Group, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2415 Boston Post Rd, Guilford, Connecticut |
| Authorized Official Name and Position | Tricia L Mignosa (OWNER) |
| Authorized Official Contact | 2036934566 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stony Creek Wellness Group, Llc 2415 Boston Post Rd Unit 12 Guilford CT 06437-4348 Ph: (203) 693-4566 | Stony Creek Wellness Group, Llc 2415 Boston Post Rd Unit 12 Guilford CT 06437-4348 Ph: (203) 693-4566 |
| NPI Number | 1598209116 |
|---|---|
| Provider Enumeration Date | 12/16/2016 |
| Last Update Date | 12/16/2016 |
| Medicare PECOS PAC ID | 3072896380 |
|---|---|
| Medicare Enrollment ID | O20170213000666 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598209116 | NPI | - | NPPES |
| Provider Name | Lyndsie C Ryalls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679903983 PECOS PAC ID: 8022249812 Enrollment ID: I20140319001959 |
| Provider Name | Tricia Mignosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770626129 PECOS PAC ID: 9234239237 Enrollment ID: I20150120001849 |
| Provider Name | Kathryn Eggert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366710139 PECOS PAC ID: 7517248628 Enrollment ID: I20170104001314 |
| Provider Name | Christopher J Mignosa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215386586 PECOS PAC ID: 5193009199 Enrollment ID: I20170310000274 |
| Provider Name | Jennifer Noto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326313289 PECOS PAC ID: 6800155144 Enrollment ID: I20180113000073 |
| Provider Name | Asim Husain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881234532 PECOS PAC ID: 2668859109 Enrollment ID: I20220523000437 |
| Provider Name | Joseph Salvatore Impellizeri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609617000 PECOS PAC ID: 1759822570 Enrollment ID: I20240920000444 |
| Provider Name | Samantha Elizabeth Clifford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326736588 PECOS PAC ID: 1850811829 Enrollment ID: I20250220001684 |
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