Healthcare Provider Details

I. General information

NPI: 1457255614
Provider Name (Legal Business Name): MICHELLE HENIA MORDASIEWICZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR STE 210
NEW HAVEN CT
06511-5591
US

IV. Provider business mailing address

1 LONG WHARF DR STE 210
NEW HAVEN CT
06511-5591
US

V. Phone/Fax

Practice location:
  • Phone: 877-925-3637
  • Fax: 203-688-4542
Mailing address:
  • Phone: 877-925-3637
  • Fax: 203-688-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: