Healthcare Provider Details

I. General information

NPI: 1740248244
Provider Name (Legal Business Name): CINDY M WASSMUTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MAIN ST SUITE 102
DANBURY CT
06810-6673
US

IV. Provider business mailing address

38B GROVE ST
RIDGEFIELD CT
06877-4665
US

V. Phone/Fax

Practice location:
  • Phone: 203-730-5929
  • Fax:
Mailing address:
  • Phone: 203-438-9557
  • Fax: 203-438-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002053
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: