Healthcare Provider Details

I. General information

NPI: 1932677879
Provider Name (Legal Business Name): ABIGAIL HADDAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 SAYBROOK RD STE 100
MIDDLETOWN CT
06457-4780
US

IV. Provider business mailing address

25 UXBRIDGE RD APT A
SUTTON MA
01590-1716
US

V. Phone/Fax

Practice location:
  • Phone: 860-685-8940
  • Fax:
Mailing address:
  • Phone: 508-335-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: