Healthcare Provider Details

I. General information

NPI: 1235049222
Provider Name (Legal Business Name): ANTHONY DEVLIN HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HARTFORD TPKE STE D3
WATERFORD CT
06385-4267
US

IV. Provider business mailing address

823 LONG COVE RD
GALES FERRY CT
06335-1912
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-7500
  • Fax:
Mailing address:
  • Phone: 860-443-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number535
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: