Healthcare Provider Details

I. General information

NPI: 1215643580
Provider Name (Legal Business Name): EMILY GAUDET CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 KING ST
HAMDEN CT
06517-2314
US

IV. Provider business mailing address

21 KING ST
HAMDEN CT
06517-2314
US

V. Phone/Fax

Practice location:
  • Phone: 203-930-1125
  • Fax:
Mailing address:
  • Phone: 774-276-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number481
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: