Individual
DR. SHAWNA MARIE KETTYLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2800 MAIN ST DEPT OF, BRIDGEPORT, CT 06606
(203) 576-6000
Mailing address
2800 MAIN ST DEPT OF, BRIDGEPORT, CT 06606-4292
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
61673
CT
Other
Enumeration date
04/09/2012
Last updated
07/27/2018
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