Provider Demographics
NPI:1205982030
Name:PAYSON, AMY A (EDD CS APRN BC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:A
Last Name:PAYSON
Suffix:
Gender:F
Credentials:EDD CS APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:16 OLD DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4954
Mailing Address - Country:US
Mailing Address - Phone:203-394-2423
Mailing Address - Fax:203-375-5619
Practice Address - Street 1:2335 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3220
Practice Address - Country:US
Practice Address - Phone:203-373-1234
Practice Address - Fax:203-375-5619
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000869363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004191101Medicaid
CT173546OtherHEALTH NET
CT400000869CT01OtherCT ANTHEM BLUE CROSS BLUE
CT122025OtherVALUE OPTIONS
CT400000869CT01OtherCT ANTHEM BLUE CROSS BLUE