Healthcare Provider Details

I. General information

NPI: 1013403682
Provider Name (Legal Business Name): STEPHANIE K. SCHMITT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE KATHERINE GOHLSCH PA-C

II. Dates (important events)

Enumeration Date: 07/07/2018
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SAYBROOK RD STE 100
MIDDLETOWN CT
06457-4788
US

IV. Provider business mailing address

512 SAYBROOK RD STE 100
MIDDLETOWN CT
06457-4788
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-7636
  • Fax:
Mailing address:
  • Phone: 860-347-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number4154
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4154
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: