Healthcare Provider Details

I. General information

NPI: 1376587584
Provider Name (Legal Business Name): KIMBERLY GUZZIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY CHEMACKI PA-C

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 PARKWAY S SUITE 103
WATERFORD CT
06385-1234
US

IV. Provider business mailing address

99 HAWLEY LN FL 3
STRATFORD CT
06614-1202
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-4383
  • Fax: 860-443-3980
Mailing address:
  • Phone: 860-443-4383
  • Fax: 860-443-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001019
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1019
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: