Healthcare Provider Details

I. General information

NPI: 1033869250
Provider Name (Legal Business Name): LAILA IMAD KNIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 LONG LOTS RD
WESTPORT CT
06880-3828
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC-CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 203-227-1251
  • Fax: 203-226-8616
Mailing address:
  • Phone: 860-972-5507
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number78837
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: