Healthcare Provider Details

I. General information

NPI: 1396533295
Provider Name (Legal Business Name): DOAA SWISSI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 NEW LONDON TPKE
NORWICH CT
06360-2645
US

IV. Provider business mailing address

108 NEW LONDON TPKE
NORWICH CT
06360-2645
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-3052
  • Fax: 860-889-0926
Mailing address:
  • Phone: 860-889-3052
  • Fax: 860-889-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7492
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: