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General NPI Number Information
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NPI Number | 1457405524
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Entity Type | Individual
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Provider Name | NICOLE JACQUELINE GAJADHAR RPA-C
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 30 BUXTON FARM RD STE 210
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City | STAMFORD
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State | CT
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Zip | 06905-1230
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Country | US
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Telephone | 203-322-7070
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Fax | 203-322-2389
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY HHC CVO
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone | 860-972-5507
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Fax | 860-972-7040
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 011033-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 7128
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License Number State | CT
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