Healthcare Provider Details

I. General information

NPI: 1558381582
Provider Name (Legal Business Name): CINDY SUE ANDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BLACK ROCK TPKE
FAIRFIELD CT
06825-5508
US

IV. Provider business mailing address

34 MAPLE ST
NORWALK CT
06850-3815
US

V. Phone/Fax

Practice location:
  • Phone: 203-337-2600
  • Fax: 203-337-2611
Mailing address:
  • Phone: 203-846-3338
  • Fax: 203-846-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5162
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA002308L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: