Individual
KELLY GIFFAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4769
(860) 442-0711
Mailing address
365 MONTAUK AVE, NEW LONDON, CT 06320-4769
(860) 442-0711
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
07/25/2023
Last updated
07/25/2023
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