Healthcare Provider Details

I. General information

NPI: 1417869751
Provider Name (Legal Business Name): PREMIER PROVIDER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MECHANIC ST, WINDSOR, CT 06095 #100-1005
WINDSOR CT
06095
US

IV. Provider business mailing address

41 MECHANIC ST, WINDSOR, CT 06095 #100-1005
WINDSOR CT
06095
US

V. Phone/Fax

Practice location:
  • Phone: 203-441-5360
  • Fax:
Mailing address:
  • Phone: 203-441-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWNEE GENESE ROCHESTER
Title or Position: CEO
Credential:
Phone: 203-441-5360