Basic Information
| Provider Information | |||||||||
| NPI: | 1205458809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEGALLA | ||||||||
| FirstName: | JEAN-A'LAYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, MSN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1102 ASPEN GLEN DR | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065185315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035029808 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 439 MILL HILL AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066102866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033342100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2020 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 12.008979 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 119335 | CT | N | Nursing Service Providers | Registered Nurse |
No ID Information.