Healthcare Provider Details

I. General information

NPI: 1346467602
Provider Name (Legal Business Name): SANDRA FRIMEL PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 HIGH ST
MIDDLETOWN CT
06459-3232
US

IV. Provider business mailing address

158 BRAINARD HILL RD
HIGGANUM CT
06441-4069
US

V. Phone/Fax

Practice location:
  • Phone: 860-685-2470
  • Fax:
Mailing address:
  • Phone: 860-345-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000405
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: