Healthcare Provider Details

I. General information

NPI: 1578214706
Provider Name (Legal Business Name): BRIANNA PERRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 GRANITE STREET SUITE D
NEW LONDON CT
06320
US

IV. Provider business mailing address

102 VALLEY RD
MIDDLETOWN RI
02842-5237
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-1419
  • Fax:
Mailing address:
  • Phone: 401-239-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01558
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number6398
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: