Healthcare Provider Details

I. General information

NPI: 1023650520
Provider Name (Legal Business Name): KRISTI XHAXHO KRIKRIS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 W MAIN ST
AVON CT
06001-4357
US

IV. Provider business mailing address

776 LONGMEADOW ST
LONGMEADOW MA
01106-2219
US

V. Phone/Fax

Practice location:
  • Phone: 860-777-1280
  • Fax:
Mailing address:
  • Phone: 413-565-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004645
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberPA7246
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: