Healthcare Provider Details

I. General information

NPI: 1245986348
Provider Name (Legal Business Name): NATHALYA ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 PARK AVE
FAIRFIELD CT
06825-1090
US

IV. Provider business mailing address

25 ROCKMEADOW RD
NORWALK CT
06850-2811
US

V. Phone/Fax

Practice location:
  • Phone: 203-371-7999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: