Healthcare Provider Details

I. General information

NPI: 1912308636
Provider Name (Legal Business Name): MIRYAM D GARAY-CIOFALO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRYAM D GARAY PA-C

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 MAIN AVE
NORWALK CT
06851-1592
US

IV. Provider business mailing address

PO BOX 1339
GLASTONBURY CT
06033-6339
US

V. Phone/Fax

Practice location:
  • Phone: 860-650-3848
  • Fax:
Mailing address:
  • Phone: 959-356-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number017980
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003321
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9303
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: