Individual
KRISTEN S WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
299 WASHINGTON AVE, HAMDEN, CT 06518-3026
(203) 288-4288
(855) 414-4010
Mailing address
299 WASHINGTON AVE, HAMDEN, CT 06518-3026
(203) 288-4288
(203) 288-1566
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
046513
CT
208000000X
Pediatrics Physician
244100
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02896880
—
CT
Enumeration date
07/19/2007
Last updated
04/30/2021
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