Provider Demographics
NPI:1871563098
Name:PYCH, CANDICE T (APRN)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:T
Last Name:PYCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3536
Mailing Address - Country:US
Mailing Address - Phone:860-646-8044
Mailing Address - Fax:860-643-4891
Practice Address - Street 1:945 MAIN ST STE 202203
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6064
Practice Address - Country:US
Practice Address - Phone:860-871-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002902363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004239217Medicaid
CTP99423Medicare UPIN
CT500001123Medicare ID - Type Unspecified