Healthcare Provider Details

I. General information

NPI: 1700717493
Provider Name (Legal Business Name): GLADYS MIDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1289 RAILROAD AVE UNIT 119
BRIDGEPORT CT
06605-2044
US

IV. Provider business mailing address

1289 RAILROAD AVE UNIT 119
BRIDGEPORT CT
06605-2044
US

V. Phone/Fax

Practice location:
  • Phone: 203-428-8431
  • Fax:
Mailing address:
  • Phone: 203-428-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberNA8298469
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: