Individual
FARA PHILIDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1 SHAWS CV, NEW LONDON, CT 06320-4902
(860) 447-8304
(860) 443-8720
Mailing address
19 GRAND ST, MIDDLETOWN, CT 06457-2705
(860) 347-6971
(860) 343-7379
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
17840
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
CT
Other
Enumeration date
07/06/2026
Last updated
07/09/2026
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