Provider Demographics
NPI:1417514183
Name:SGAMBELLURI, KAYLA (LMT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SGAMBELLURI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 NEWINGTON AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2107
Mailing Address - Country:US
Mailing Address - Phone:203-690-4756
Mailing Address - Fax:
Practice Address - Street 1:2934 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1089
Practice Address - Country:US
Practice Address - Phone:860-657-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist