Healthcare Provider Details

I. General information

NPI: 1457107294
Provider Name (Legal Business Name): CAITLYN ANN SHETLAND BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ORCHARD ST STE 107
NEW HAVEN CT
06511-4430
US

IV. Provider business mailing address

363 BRIDGEPORT AVE APT D
MILFORD CT
06460-4173
US

V. Phone/Fax

Practice location:
  • Phone: 203-200-4362
  • Fax: 203-200-1362
Mailing address:
  • Phone: 860-917-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: