Basic Information
| Provider Information | |||||||||
| NPI: | 1063888410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALLISSEY | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PARK ST | ||||||||
| Address2: | PEDIATRIC HEMATOLOGY/ONCOLOGY | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065048901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854640 | ||||||||
| FaxNumber: | 2037372228 | ||||||||
| Practice Location | |||||||||
| Address1: | 5520 PARK AVENUE | ||||||||
| Address2: | PEDIATRIC HEMATOLOGY AND ONCOLOGY | ||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066113463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854640 | ||||||||
| FaxNumber: | 2037372228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2015 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | F382554 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | 9461 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.