Provider Demographics
NPI:1356999866
Name:FLOUTY, TREVOR M
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:M
Last Name:FLOUTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CARY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1332
Mailing Address - Country:US
Mailing Address - Phone:203-559-0439
Mailing Address - Fax:
Practice Address - Street 1:532 E PUTNAM AVE STE 22
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807
Practice Address - Country:US
Practice Address - Phone:203-559-0439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001560374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide