Healthcare Provider Details

I. General information

NPI: 1538617204
Provider Name (Legal Business Name): KAYLA N ST HILAIRE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 FRANKLIN ST
WATERBURY CT
06706-1238
US

IV. Provider business mailing address

60 HARTLAND ST 3RD FLOOR CBO
EAST HARTFORD CT
06108-3250
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9000
  • Fax:
Mailing address:
  • Phone: 860-837-5615
  • Fax: 860-837-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: