Healthcare Provider Details

I. General information

NPI: 1194457127
Provider Name (Legal Business Name): ALYSSA PILKINGTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 NEW BRITAIN RD
BERLIN CT
06037-1395
US

IV. Provider business mailing address

279 NEW BRITAIN RD
BERLIN CT
06037-1395
US

V. Phone/Fax

Practice location:
  • Phone: 860-756-0455
  • Fax:
Mailing address:
  • Phone: 860-756-0455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number18917634
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: