Healthcare Provider Details

I. General information

NPI: 1609735083
Provider Name (Legal Business Name): KLAYTON BANEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DANBURY RD
WILTON CT
06897-4405
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-2200
  • Fax:
Mailing address:
  • Phone: 623-241-8682
  • Fax: 480-499-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number7531
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7531
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: