Healthcare Provider Details

I. General information

NPI: 1194549840
Provider Name (Legal Business Name): GAELYN VICTORIA KATTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2700
US

V. Phone/Fax

Practice location:
  • Phone: 860-597-0701
  • Fax:
Mailing address:
  • Phone: 860-597-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12.017621
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number181389
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: