Healthcare Provider Details

I. General information

NPI: 1144055468
Provider Name (Legal Business Name): SUSAN HASSAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CELLINI PL STE 102
WEST HAVEN CT
06516-1666
US

IV. Provider business mailing address

69 POPE ST
NEW HAVEN CT
06512-3655
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-6481
  • Fax:
Mailing address:
  • Phone: 857-294-3467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7466
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: