Healthcare Provider Details

I. General information

NPI: 1285870121
Provider Name (Legal Business Name): JENNIFER PIELECH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JENNIFER SZYNALSKI

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WASHINGTON AVE STE 3A
HAMDEN CT
06518-3267
US

IV. Provider business mailing address

67 MAPLE AVE
DERBY CT
06418-1328
US

V. Phone/Fax

Practice location:
  • Phone: 475-227-3614
  • Fax: 844-219-8679
Mailing address:
  • Phone: 203-732-1330
  • Fax: 203-732-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number02201
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: