Healthcare Provider Details

I. General information

NPI: 1932041324
Provider Name (Legal Business Name): ALEXIS RULLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MAIN ST
DANBURY CT
06810-7832
US

IV. Provider business mailing address

52 OLD FARM RD
NEW FAIRFIELD CT
06812-2623
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-8100
  • Fax:
Mailing address:
  • Phone: 203-885-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number069019492
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: