Healthcare Provider Details

I. General information

NPI: 1700883709
Provider Name (Legal Business Name): GABRIELLA ELIZABETH SMITH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALBANY AVE
HARTFORD CT
06120-2508
US

IV. Provider business mailing address

500 ALBANY AVE
HARTFORD CT
06120-2508
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-9625
  • Fax: 860-808-1581
Mailing address:
  • Phone: 860-249-9625
  • Fax: 860-808-1581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000729
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: