Healthcare Provider Details

I. General information

NPI: 1588397921
Provider Name (Legal Business Name): ASHLEY NICOLE UTTERMANN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
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

185 CANAL ST UNIT 4102
SHELTON CT
06484-8147
US

V. Phone/Fax

Practice location:
  • Phone: 203-468-9775
  • Fax:
Mailing address:
  • Phone: 516-661-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: