Provider Demographics
NPI:1770455511
Name:PETERSON, TREY M
Entity type:Individual
Prefix:
First Name:TREY
Middle Name:M
Last Name:PETERSON
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 1:465 BUCKLAND HILLS DR APT 22232
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-9103
Mailing Address - Country:US
Mailing Address - Phone:469-215-0712
Mailing Address - Fax:
Practice Address - Street 1:465 BUCKLAND HILLS DR APT 22232
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-9103
Practice Address - Country:US
Practice Address - Phone:469-215-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program