Healthcare Provider Details

I. General information

NPI: 1245913045
Provider Name (Legal Business Name): MISS JACQUELYN AURORA GIANNELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MAIN AVE STE 115
NORWALK CT
06851-1080
US

IV. Provider business mailing address

2 RIVERVIEW DR
DANBURY CT
06810-6268
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-2200
  • Fax:
Mailing address:
  • Phone: 203-845-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: