Healthcare Provider Details

I. General information

NPI: 1598631699
Provider Name (Legal Business Name): NEWTOWN MEDISPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CHURCH HILL RD
NEWTOWN CT
06470-1642
US

IV. Provider business mailing address

34 CHURCH HILL RD
NEWTOWN CT
06470-1642
US

V. Phone/Fax

Practice location:
  • Phone: 203-304-9725
  • Fax:
Mailing address:
  • Phone: 203-304-9725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA SULLIVAN
Title or Position: OWNER/CEO
Credential: PA-C
Phone: 203-304-1076