Healthcare Provider Details

I. General information

NPI: 1578320677
Provider Name (Legal Business Name): JACQUELINE SCHON KEGEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 IRONWOOD RD
GUILFORD CT
06437-4714
US

IV. Provider business mailing address

60 IRONWOOD RD
GUILFORD CT
06437-4714
US

V. Phone/Fax

Practice location:
  • Phone: 203-915-3172
  • Fax:
Mailing address:
  • Phone: 203-915-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00913400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: