Provider Demographics
NPI:1215546528
Name:GADALLA, ERNESTA D (RN)
Entity Type:Individual
Prefix:MRS
First Name:ERNESTA
Middle Name:D
Last Name:GADALLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 OLD BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-7222
Mailing Address - Country:US
Mailing Address - Phone:203-690-6611
Mailing Address - Fax:
Practice Address - Street 1:805 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-6805
Practice Address - Country:US
Practice Address - Phone:203-696-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT142757163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty