| Doctor Name: | CARLY MELISSA MADORE |
| NPI Number: | 1396012498 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 4830 |
| Business Practice Address: | 248 Flanders Rd Niantic, CT - 063571264 |
| Business Phone Number: | 8607395426 |
| Business Fax Number: | |
| Mailing Address: | 32 Plains Rd, HADDAM |
| State: | CT |
| Postal Code: | 064381259 |
| Phone Number: | 8607147420 |
| Fax Number: | |
| NPI Enumeration Date: | 11/18/2011 |
| NPI Last Update Date: | 09/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 4830 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |