Healthcare Provider Details

I. General information

NPI: 1023783271
Provider Name (Legal Business Name): SEZAI USTUN AYDIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 GEORGE ST
NEW HAVEN CT
06511-5410
US

IV. Provider business mailing address

425 GEORGE ST
NEW HAVEN CT
06511-5410
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-3182
  • Fax:
Mailing address:
  • Phone: 203-688-3182
  • Fax: 203-688-3596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number1.083068
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: