Healthcare Provider Details

I. General information

NPI: 1053240127
Provider Name (Legal Business Name): KDM HEART OF PHLEBOTOMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 MERIDEN WTBY TPKE
MILLDALE CT
06467-6507
US

IV. Provider business mailing address

1656 MERIDEN WTBY TPKE
MILLDALE CT
06467-6507
US

V. Phone/Fax

Practice location:
  • Phone: 203-220-1804
  • Fax:
Mailing address:
  • Phone: 203-220-1804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. EDDANESHIA YOLANDA PARKS
Title or Position: PHLEBOTOMIST
Credential:
Phone: 203-220-1804