Healthcare Provider Details

I. General information

NPI: 1891256186
Provider Name (Legal Business Name): JESSICA FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

30 AVALON DR UNIT 5211
MILFORD CT
06460-8591
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3000
  • Fax:
Mailing address:
  • Phone: 916-599-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number5939
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5939
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: