Healthcare Provider Details

I. General information

NPI: 1528878238
Provider Name (Legal Business Name): ANN GABRIELLE PASTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE
DANBURY CT
06810-6077
US

IV. Provider business mailing address

1078 DREXEL WAY
SAN JOSE CA
95121-2712
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-6959
  • Fax:
Mailing address:
  • Phone: 408-643-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7643
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: