Provider Demographics
NPI:1659406486
Name:DILEO, GAETANA (LAT,ATC)
Entity Type:Individual
Prefix:MRS
First Name:GAETANA
Middle Name:
Last Name:DILEO
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:MS
Other - First Name:GAETANA
Other - Middle Name:
Other - Last Name:DEISO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT,ATC
Mailing Address - Street 1:82 BLACKBIRCH CT
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3873
Mailing Address - Country:US
Mailing Address - Phone:203-209-9573
Mailing Address - Fax:
Practice Address - Street 1:70 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2720
Practice Address - Country:US
Practice Address - Phone:203-341-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer