Healthcare Provider Details

I. General information

NPI: 1942418355
Provider Name (Legal Business Name): PAULA K BERRY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WATSON BLVD
STRATFORD CT
06615-7127
US

IV. Provider business mailing address

193 STONEHEDGE
SHELTON CT
06484-2865
US

V. Phone/Fax

Practice location:
  • Phone: 203-380-4553
  • Fax: 203-380-4554
Mailing address:
  • Phone: 203-929-1118
  • Fax: 203-929-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: