Healthcare Provider Details

I. General information

NPI: 1104002849
Provider Name (Legal Business Name): STEPHANIE BEHRENS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MESSICK PA

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SOUTH RD STE 110
FARMINGTON CT
06032-2482
US

IV. Provider business mailing address

160 WINDERMERE AVE APT 3501
ELLINGTON CT
06029-3938
US

V. Phone/Fax

Practice location:
  • Phone: 860-284-4945
  • Fax: 860-284-4946
Mailing address:
  • Phone: 302-359-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3250
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC5-0000601
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: