Individual
MICHAEL DISTASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
YALE NEW HAVEN HEALTH, 789 HOWARD AVENUE, NEW HAVEN, CT 06460
(203) 430-6379
Mailing address
69 CARRIAGE PATH S, MILFORD, CT 06460-7544
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
154019
CT
363LF0000X
Family Nurse Practitioner
Primary
14094
CT
Other
Enumeration date
02/14/2024
Last updated
12/05/2024
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