Healthcare Provider Details

I. General information

NPI: 1760035547
Provider Name (Legal Business Name): STEPHEN JASON SASSO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2019
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HAZARD AVE
ENFIELD CT
06082-3826
US

IV. Provider business mailing address

41 BREWSTER RD DEPT LEVELC
BRISTOL CT
06010-5141
US

V. Phone/Fax

Practice location:
  • Phone: 855-349-2828
  • Fax:
Mailing address:
  • Phone: 860-585-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9418
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4519
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9418
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4519
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: