# STAYWELL PEDIATRIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255521019
- **Authorized official:** DR. THOMAS ETKIN M.D. (OWNER)
- **Authorized official phone:** (230) 932-3227

## Contact information

- **Practice address:** 365 ELM ST, WEST HAVEN, CT 06516-4217
- **Practice address phone:** (203) 932-3227
- **Practice address fax:** (203) 931-2847
- **Mailing address:** 365 ELM ST, WEST HAVEN, CT 06516-4217
- **Mailing address phone:** (203) 932-3227
- **Mailing address fax:** (203) 931-2847

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0200X | Pediatric Nurse Practitioner | 000373 | CT | Yes |

## Other

- **Enumeration date:** 07/27/2007
- **Last updated:** 07/27/2007