Healthcare Provider Details

I. General information

NPI: 1437099066
Provider Name (Legal Business Name): ATO ADDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PARK POND CIR
WALLINGFORD CT
06492-2152
US

IV. Provider business mailing address

60 PARK POND CIR
WALLINGFORD CT
06492-2152
US

V. Phone/Fax

Practice location:
  • Phone: 475-361-3788
  • Fax: 475-361-3788
Mailing address:
  • Phone: 475-361-3788
  • Fax: 475-361-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: