Healthcare Provider Details

I. General information

NPI: 1912321803
Provider Name (Legal Business Name): DAVID IRVING ALLYN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CELLINI PL STE 102
WEST HAVEN CT
06516-1666
US

IV. Provider business mailing address

1 CELLINI PL STE 102
WEST HAVEN CT
06516-1666
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-6481
  • Fax: 203-932-4051
Mailing address:
  • Phone: 203-932-6481
  • Fax: 203-932-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3059
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: