Healthcare Provider Details

I. General information

NPI: 1144135708
Provider Name (Legal Business Name): BAIJE J NEALY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 S TURNPIKE RD
WALLINGFORD CT
06492-4340
US

IV. Provider business mailing address

32 CONSTITUTION DR
WOLCOTT CT
06716-2684
US

V. Phone/Fax

Practice location:
  • Phone: 860-440-7288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-405339
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: