Individual
KEVIN FASULO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
80 SEYMOUR ST, HARTFORD, CT 06106-3315
(860) 545-5000
Mailing address
22B POND MEADOW RD, IVORYTON, CT 06442-1168
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
209589
CT
Other
Enumeration date
07/08/2026
Last updated
07/08/2026
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