Healthcare Provider Details

I. General information

NPI: 1154797934
Provider Name (Legal Business Name): MAUREEN WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 SHERMAN AVE
NEW HAVEN CT
06511-4357
US

IV. Provider business mailing address

175 SHERMAN AVE
NEW HAVEN CT
06511-4357
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3363
  • Fax: 203-789-4081
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: