Healthcare Provider Details

I. General information

NPI: 1497086854
Provider Name (Legal Business Name): KIMBERLY A SWEEZY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 ALVORD PARK RD
TORRINGTON CT
06790-3493
US

IV. Provider business mailing address

270 FARMINGTON AVE STE 102
FARMINGTON CT
06032-1920
US

V. Phone/Fax

Practice location:
  • Phone: 860-482-8539
  • Fax: 860-482-0258
Mailing address:
  • Phone: 860-549-8276
  • Fax: 860-674-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: