Healthcare Provider Details

I. General information

NPI: 1043101140
Provider Name (Legal Business Name): MAIA ANNUNZIATO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

20 WINCHESTER DR
NORTH HAVEN CT
06473-3466
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4000
  • Fax:
Mailing address:
  • Phone: 860-714-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7313
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: