Healthcare Provider Details

I. General information

NPI: 1003652694
Provider Name (Legal Business Name): EMMA L BREYAN MS. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CHURCH HILL RD STE 2
NEWTOWN CT
06470-1637
US

IV. Provider business mailing address

20 BRINSMAID RD
MONROE CT
06468-2050
US

V. Phone/Fax

Practice location:
  • Phone: 475-282-0932
  • Fax:
Mailing address:
  • Phone: 203-615-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7803
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: