Healthcare Provider Details

I. General information

NPI: 1316476633
Provider Name (Legal Business Name): LILIYA DICHIARO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILIYA TERESHCHUK

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/30/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

3 ERIC DR
GRANBY CT
06035-1123
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-5022
  • Fax:
Mailing address:
  • Phone: 413-454-3807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1138621
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number4680
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: