Healthcare Provider Details

I. General information

NPI: 1306570320
Provider Name (Legal Business Name): RUDAE GADSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 STANLEY ST
NEW BRITAIN CT
06053-2439
US

IV. Provider business mailing address

PO BOX 127
WESTBROOKVILLE NY
12785-0127
US

V. Phone/Fax

Practice location:
  • Phone: 845-326-7226
  • Fax:
Mailing address:
  • Phone: 845-326-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: