Individual
TRACEY MELISSA MODESTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 CHURCH ST STE 15, NAUGATUCK, CT 06770-2836
(203) 729-6641
(203) 575-5206
Mailing address
64 ROBBINS STREET, WATERBURY HOSPITAL,, WATERBURY, CT 06708
(203) 573-6162
(203) 573-6707
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
66924
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2017
Last updated
01/21/2022
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