Healthcare Provider Details

I. General information

NPI: 1649606385
Provider Name (Legal Business Name): CONNECTICUT SKINHEALTH LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CORPORATE DR SUITE 386
SHELTON CT
06484-6211
US

IV. Provider business mailing address

4 CORPORATE DR SUITE 386
SHELTON CT
06484-6211
US

V. Phone/Fax

Practice location:
  • Phone: 203-538-5685
  • Fax:
Mailing address:
  • Phone: 203-538-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number040226
License Number StateCT

VIII. Authorized Official

Name: DR. LOYD S. GODWIN
Title or Position: PRESIDENT
Credential: MD
Phone: 917-693-9851