Healthcare Provider Details

I. General information

NPI: 1689297418
Provider Name (Legal Business Name): AMANDA CATHERINE CRUESS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEWIS AVE STE 105
MERIDEN CT
06451-2121
US

IV. Provider business mailing address

455 LEWIS AVE STE 105
MERIDEN CT
06451-2121
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-2477
  • Fax:
Mailing address:
  • Phone: 203-237-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4894
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4894
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: