Provider Demographics
NPI:1730271024
Name:PORRELLO, PAIGE REID (AUD)
Entity type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:REID
Last Name:PORRELLO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N MAIN STREET EXT STE 1C
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2487
Mailing Address - Country:US
Mailing Address - Phone:203-741-9943
Mailing Address - Fax:203-741-9167
Practice Address - Street 1:149 WAKELEE AVENUE
Practice Address - Street 2:THE HEARING CENTER LLC
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401
Practice Address - Country:US
Practice Address - Phone:203-735-4327
Practice Address - Fax:203-735-2539
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT291237600000X, 231H00000X
237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004245412OtherFOR TESTING FOR MEDICAID
CT004245412Medicaid
CT4015020OtherFAC# FOR DURABLE MEDICAL
CT4015020Medicaid