Provider Demographics
NPI:1104691898
Name:REYNOLDS, ALLYSON PAIGE (APRN)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:PAIGE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 WASHINGTON AVE STE LL
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3039
Mailing Address - Country:US
Mailing Address - Phone:203-288-4288
Mailing Address - Fax:
Practice Address - Street 1:299 WASHINGTON AVE STE LL
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3039
Practice Address - Country:US
Practice Address - Phone:203-288-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12639363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics