Healthcare Provider Details

I. General information

NPI: 1417549379
Provider Name (Legal Business Name): MARIA L WESELYJ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 1003
HARTFORD CT
06106-5529
US

IV. Provider business mailing address

85 SEYMOUR ST STE 1003
HARTFORD CT
06106-5529
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-2780
  • Fax:
Mailing address:
  • Phone: 860-972-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5440
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5440
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: