Individual
LISA MENILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 FARMINGTON AVE, BRISTOL, CT 06010-4776
(860) 589-4501
(860) 589-4502
Mailing address
1301 FARMINGTON AVE, BRISTOL, CT 06010-4776
(860) 589-4501
(860) 589-4502
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
030842
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001308429
—
CT
Enumeration date
07/13/2005
Last updated
10/08/2020
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