Healthcare Provider Details

I. General information

NPI: 1760895866
Provider Name (Legal Business Name): KELLY SUE SAYRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 HIGH ST
BRISTOL CT
06010-5820
US

IV. Provider business mailing address

33 HIGH ST
BRISTOL CT
06010-5820
US

V. Phone/Fax

Practice location:
  • Phone: 860-540-4220
  • Fax:
Mailing address:
  • Phone: 860-540-4220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number83381
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: