Healthcare Provider Details

I. General information

NPI: 1013403849
Provider Name (Legal Business Name): DEVIN PATRICK PRAY NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WILLARD AVE
NEWINGTON CT
06111-2631
US

IV. Provider business mailing address

950 CAMPBELL AVE BLDG 2B
WEST HAVEN CT
06516-2770
US

V. Phone/Fax

Practice location:
  • Phone: 860-666-6951
  • Fax: 860-667-6875
Mailing address:
  • Phone: 203-932-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number12.007701
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.124355
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: