Healthcare Provider Details

I. General information

NPI: 1619795614
Provider Name (Legal Business Name): JENNA NICOLE DOTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-8063
US

IV. Provider business mailing address

1400 LOCUST ST STE 300
PITTSBURGH PA
15219-5114
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-8080
  • Fax: 860-679-1430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number7855
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: