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General NPI Number Information
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NPI Number | 1235435835
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Entity Type | Individual
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Provider Name | KIRSTEN DEEDS GRILLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 333 KENNEDY DR SUITE L201
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City | TORRINGTON
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State | CT
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Zip | 06790-3060
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Country | US
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Telephone | 860-806-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 333 KENNEDY DR SUITE L201
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City | TORRINGTON
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State | CT
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Zip | 06790-3060
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Country | US
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Telephone | 860-806-0557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA4125
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2558
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License Number State | CT
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