Provider Demographics
NPI:1295254340
Name:GASTON, SIOBHAN ASHLEY (APRN)
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:ASHLEY
Last Name:GASTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W THAMES ST BLDG 301
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-7155
Mailing Address - Country:US
Mailing Address - Phone:860-859-4738
Mailing Address - Fax:860-859-4672
Practice Address - Street 1:401 W THAMES ST BLDG 301
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-7155
Practice Address - Country:US
Practice Address - Phone:860-859-4738
Practice Address - Fax:860-859-4672
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6177363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily