Healthcare Provider Details

I. General information

NPI: 1477483451
Provider Name (Legal Business Name): GISSELLE LEE CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 STEWART ST APT 3
BRISTOL CT
06010-4328
US

IV. Provider business mailing address

102 STEWART ST APT 3
BRISTOL CT
06010-4328
US

V. Phone/Fax

Practice location:
  • Phone: 475-235-8889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: