Healthcare Provider Details

I. General information

NPI: 1366166910
Provider Name (Legal Business Name): AMANDA COMEAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 N MAIN ST STE 5
BRANFORD CT
06405-3044
US

IV. Provider business mailing address

144 N MAIN ST STE 5
BRANFORD CT
06405-3044
US

V. Phone/Fax

Practice location:
  • Phone: 203-468-9775
  • Fax:
Mailing address:
  • Phone: 203-468-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5767
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: