Healthcare Provider Details

I. General information

NPI: 1558276824
Provider Name (Legal Business Name): ANYSE KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 PARK AVE
FAIRFIELD CT
06825-1090
US

IV. Provider business mailing address

6 SCOTT AVE
SEYMOUR CT
06483-3227
US

V. Phone/Fax

Practice location:
  • Phone: 972-829-1591
  • Fax:
Mailing address:
  • Phone: 972-829-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230816
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: