Healthcare Provider Details

I. General information

NPI: 1720499940
Provider Name (Legal Business Name): ALEXA RAY CLEMENT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COTTAGE GROVE RD STE 230
BLOOMFIELD CT
06002-3080
US

IV. Provider business mailing address

12 SCARBOROUGH RD
SIMSBURY CT
06070-1261
US

V. Phone/Fax

Practice location:
  • Phone: 860-595-5525
  • Fax:
Mailing address:
  • Phone: 203-228-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number61436
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: