Healthcare Provider Details

I. General information

NPI: 1508393521
Provider Name (Legal Business Name): ROBIN LEIGH FIFTAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK ST
NEW HAVEN CT
06504-8901
US

IV. Provider business mailing address

39 OLD COLONY RD
MONROE CT
06468-1279
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-3000
  • Fax:
Mailing address:
  • Phone: 203-331-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3854
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: