Healthcare Provider Details

I. General information

NPI: 1538618921
Provider Name (Legal Business Name): KAITLYN HENDREY DEPAOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN HENDREY REID

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 06/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052
US

IV. Provider business mailing address

11781 LEE JACKSON MEMORIAL HWY STE 550
FAIRFAX VA
22033-3309
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5011
  • Fax:
Mailing address:
  • Phone: 571-777-5164
  • Fax: 703-890-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100261
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: