Healthcare Provider Details

I. General information

NPI: 1346187366
Provider Name (Legal Business Name): SEVI CT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 CAMPBELL AVE STE E
WEST HAVEN CT
06516-3786
US

IV. Provider business mailing address

764 CAMPBELL AVE STE E
WEST HAVEN CT
06516-3786
US

V. Phone/Fax

Practice location:
  • Phone: 203-931-0034
  • Fax:
Mailing address:
  • Phone: 203-931-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PIYUSH GUPTA
Title or Position: CEO
Credential: MD
Phone: 203-685-1653