Healthcare Provider Details

I. General information

NPI: 1942866793
Provider Name (Legal Business Name): LIVWELL PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 203-443-9500
  • Fax: 203-902-0509
Mailing address:
  • Phone: 203-439-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KRIPA PLAPETTA DAMODHARAN
Title or Position: APRN
Credential: DNP, FNP -BC
Phone: 203-443-9500