Daresa Gordon, is a
Lactation Consultant, Non-rn based in Manchester, Connecticut. Daresa Gordon is licensed to practice in Connecticut (license number ) and her current practice location is
38 Cone St, Manchester, Connecticut. She can be reached at her office (for appointments etc.) via phone at
(860) 478-5343.
NPI number for Daresa Gordon is 1053260208 and her current mailing address is 38 Cone St, Manchester, Connecticut. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1053260208.
Provider's Profile
| Full Name | Daresa Gordon |
|---|
| Gender | Female |
|---|
| Speciality | Lactation Consultant, Non-rn |
|---|
| Location | 38 Cone St, Manchester, Connecticut |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1053260208
- Provider Enumeration Date: 01/22/2026
- Last Update Date: 01/22/2026
Medical Identifiers
Medical identifiers for Daresa Gordon such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1053260208 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 164W00000X | Licensed Practical Nurse | 028566 (Connecticut) | Secondary |
| 174N00000X | Lactation Consultant, Non-rn | (Connecticut) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Daresa Gordon is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Daresa Gordon, 38 Cone St, Manchester, CT 06040-4450 Ph: (860) 478-5343 | Daresa Gordon, 38 Cone St, Manchester, CT 06040-4450 Ph: (860) 478-5343 |
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