Healthcare Provider Details

I. General information

NPI: 1598910697
Provider Name (Legal Business Name): ROSE SFERLAZZA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HIGHLAND AVE SCHOOL BASED HEALTH CENTER AT BMHS
NORWALK CT
06854-4029
US

IV. Provider business mailing address

4 ISLAND DR
NORWALK CT
06855-2703
US

V. Phone/Fax

Practice location:
  • Phone: 203-854-0524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000515
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMS1653422
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: