Healthcare Provider Details

I. General information

NPI: 1467089045
Provider Name (Legal Business Name): JESSICA WASSEF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HOSPITAL PLZ STE 604
STAMFORD CT
06902-3602
US

IV. Provider business mailing address

29 HOSPITAL PLZ STE 604
STAMFORD CT
06902-3602
US

V. Phone/Fax

Practice location:
  • Phone: 203-323-8989
  • Fax: 203-975-9904
Mailing address:
  • Phone: 203-323-8989
  • Fax: 203-975-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number85429
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: