Healthcare Provider Details

I. General information

NPI: 1710008057
Provider Name (Legal Business Name): JAN E MCCAULEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DANBURY RD STE 100
WILTON CT
06897-4405
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-2200
  • Fax: 203-847-1940
Mailing address:
  • Phone: 623-241-8682
  • Fax: 480-499-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001501
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1501
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: