Healthcare Provider Details

I. General information

NPI: 1437326923
Provider Name (Legal Business Name): MONICA MASSABNI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CONNECTICUT BLVD
EAST HARTFORD CT
06108-3013
US

IV. Provider business mailing address

94 CONNECTICUT BLVD
EAST HARTFORD CT
06108-3013
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-1359
  • Fax: 860-290-4142
Mailing address:
  • Phone: 860-528-1359
  • Fax: 860-290-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002084
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: