Healthcare Provider Details

I. General information

NPI: 1639016280
Provider Name (Legal Business Name): RILEY ELIZABETH PICKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST SOUTH BUILDING 502
HARTFORD CT
06102-5037
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC-CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-0549
  • Fax: 860-545-5221
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7863
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: