Individual
DR. IVELISSE RIVERA-GODREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
134 STATE ST, MERIDEN, CT 06450-3293
(203) 237-2229
(203) 686-1677
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
047088
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D400001144
MEDICARE
—
Enumeration date
07/12/2006
Last updated
08/19/2010
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