Healthcare Provider Details

I. General information

NPI: 1952225799
Provider Name (Legal Business Name): AIDAN KELLY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CONNECTICUT AVE
NORWALK CT
06854-1940
US

IV. Provider business mailing address

104 SHOREHAM VILLAGE DR
FAIRFIELD CT
06824-6251
US

V. Phone/Fax

Practice location:
  • Phone: 203-285-3253
  • Fax: 860-812-2014
Mailing address:
  • Phone: 203-299-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: