Healthcare Provider Details

I. General information

NPI: 1154245918
Provider Name (Legal Business Name): KENNETH CONNOLLY PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LAKESIDE AVE
MIDDLETOWN CT
06457-4153
US

IV. Provider business mailing address

109 LAKESIDE AVE
MIDDLETOWN CT
06457-4153
US

V. Phone/Fax

Practice location:
  • Phone: 203-231-1855
  • Fax:
Mailing address:
  • Phone: 203-231-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number3807
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: