Healthcare Provider Details

I. General information

NPI: 1578495198
Provider Name (Legal Business Name): PAULO FERNANDES MS,ATC,LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 DANBURY RD
WILTON CT
06897-2093
US

IV. Provider business mailing address

16 DEAL DR
DANBURY CT
06810-8355
US

V. Phone/Fax

Practice location:
  • Phone: 203-762-0381
  • Fax:
Mailing address:
  • Phone: 203-919-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000478
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: