Healthcare Provider Details

I. General information

NPI: 1659618379
Provider Name (Legal Business Name): SHENEETA MECHELLE WATTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHENEETA MECHELLE TRAMMELL PA

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 09/11/2025
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MAIN ST
MIDDLETOWN CT
06457-2732
US

IV. Provider business mailing address

2330 SCENIC HWY S
SNELLVILLE GA
30078-3115
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax: 860-638-6831
Mailing address:
  • Phone: 678-632-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6770
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: