Healthcare Provider Details

I. General information

NPI: 1578546925
Provider Name (Legal Business Name): ERIKA LEIGH SKINNON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA LEIGH LARSON PA

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 STRAITS TPKE
MIDDLEBURY CT
06762
US

IV. Provider business mailing address

1579 STRAITS TURNPIKE
MIDDLEBURY CT
06762
US

V. Phone/Fax

Practice location:
  • Phone: 203-598-0700
  • Fax: 203-598-0076
Mailing address:
  • Phone: 203-598-0700
  • Fax: 203-598-0076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001527
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: