Healthcare Provider Details

I. General information

NPI: 1669524526
Provider Name (Legal Business Name): CHRISTOPHER ALAN CAVANNA PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRIS ALAN CAVANNA PAC

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HAYNES ST
MANCHESTER CT
06040-4131
US

IV. Provider business mailing address

233 LUDLOW RD
MANCHESTER CT
06040-4546
US

V. Phone/Fax

Practice location:
  • Phone: 860-647-4721
  • Fax:
Mailing address:
  • Phone: 860-990-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000530
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: