Healthcare Provider Details

I. General information

NPI: 1700606209
Provider Name (Legal Business Name): LAURA GAYNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR FL 2
NEW HAVEN CT
06511-5991
US

IV. Provider business mailing address

1073 N BENSON RD
FAIRFIELD CT
06824-5195
US

V. Phone/Fax

Practice location:
  • Phone: 877-925-3637
  • Fax:
Mailing address:
  • Phone: 203-254-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15167
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: