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General NPI Number Information
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NPI Number | 1285776708
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Entity Type | Individual
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Provider Name | LISA LOUISE BRAILEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 1 FOREST PKWY DIANON SYSTEMS
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City | SHELTON
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State | CT
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Zip | 06484-6147
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Country | US
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Telephone | 203-926-7124
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Fax |
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Provider Business Mailing Address
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Address Line | 21 GROVE AVE
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City | DERBY
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State | CT
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Zip | 06418-1615
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Country | US
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Telephone | 203-906-6883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SC0300X
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Taxonomy Name | Clinical Cytogenetics Physician
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License Number | 041659
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 041659
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207SG0203X
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Taxonomy Name | Clinical Molecular Genetics Physician
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License Number | 041659
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License Number State | CT
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