Healthcare Provider Details

I. General information

NPI: 1821389040
Provider Name (Legal Business Name): BETTY EXUME PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL PLAZA
STAMFORD CT
06904
US

IV. Provider business mailing address

ONE HOSPITAL PLAZA
STAMFORD CT
06904
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-7298
  • Fax: 203-355-4842
Mailing address:
  • Phone: 203-276-7298
  • Fax: 203-355-4842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002551
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: