Healthcare Provider Details

I. General information

NPI: 1801202072
Provider Name (Legal Business Name): KAYLA P GERMANO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA GERMANO POTTBECKER PA-C

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 LITCHFIELD ST STE 202
TORRINGTON CT
06790-6669
US

IV. Provider business mailing address

538 LITCHFIELD ST STE 202
TORRINGTON CT
06790-6669
US

V. Phone/Fax

Practice location:
  • Phone: 860-361-6650
  • Fax: 860-361-6654
Mailing address:
  • Phone: 860-361-6650
  • Fax: 860-361-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3104
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: