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General NPI Number Information
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NPI Number | 1598631699
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Entity Type | Organization
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Legal Business Name | NEWTOWN MEDISPA
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 34 CHURCH HILL RD
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City | NEWTOWN
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State | CT
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Zip | 06470-1642
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Country | US
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Telephone | 203-304-9725
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Fax |
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Provider Business Mailing Address
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Address Line | 34 CHURCH HILL RD
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City | NEWTOWN
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State | CT
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Zip | 06470-1642
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Country | US
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Telephone | 203-304-9725
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DEBRA SULLIVAN
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Credential | PA-C
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Telephone | 203-304-1076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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