Healthcare Provider Details

I. General information

NPI: 1871234724
Provider Name (Legal Business Name): RYAN GELINAS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HILLCREST DR
STAFFORD SPRINGS CT
06076-3323
US

IV. Provider business mailing address

15 HILLCREST DR
STAFFORD SPRINGS CT
06076-3323
US

V. Phone/Fax

Practice location:
  • Phone: 860-798-3942
  • Fax:
Mailing address:
  • Phone: 860-798-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: